Communicable vs Non-Communicable Diseases

Introduction to Communicable and Non-Communicable Diseases
A communicable disease is an illness due to a specific infectious (biological) agent or its

toxic products capable of being directly or indirectly transmitted from man to man, from
animal to man, from animal to animal, or from the environment (through air, water, food,
etc..) to man.
Communicable disease: a disease that can be spread to a person from another person, an
animal or object. Ex: common cold, influenza, tuberculosis, etc.
Non-communicable disease: a disease that can NOT be spread from person to person. Eg:
cancer, heart disease, cirrhosis, etc.
Common Pathogens:
Viruses, Bacteria, Fungi & Protozoa
 Virus: smallest simplest life form. It causes upper respiratory infections and many
other type of diseases.
 Bacteria: simple one-celled organisms. They are everywhere. Not all bacteria is bad.
 Fungi: more complex than bacteria, but cannot make their own food. Thrive in warm,
moist environments.
 Protozoa: one celled, animal like organisms.
Communicable versus non-communicable diseases
No. Communicable Non- Communicable diseases

diseases
1. Sudden onset Gradual onset
2. Single cause Multiple causes
3. Short natural history Long natural history
4. Short treatment schedule Prolonged treatment
5. Cure is achieved Care predominates
6. Short follow up Prolonged follow up
7. Back to normalcy Quality of life after treatment
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The poor hygiene behaviors promote the transmission of infectious diseases. The fecal-oral
and respiratory routes are the most common sources of transmission.Young children and
adults may not wash their hands after using toilets and before eating/preparing food.
COMMUNICABLE DISEASES
Definition of terms
Infection
Infection is the entry and development or multiplication of an infectious agent in the body
of man or animals. An infection does not always cause illness. There are several levels of
infection also known as Gradients of infection:
a. Colonization (S. aureus in skin and normal nasopharynx)Germs can also be in or on the
body, but not make you sick. This is called colonization
b. Subclinical or inapparent infection (polio): presence of infection in a host without the
occurrence of recognizable symptoms or signs.
c. Latent infection (virus of herpes simplex) - Virus latency (or viral latency) is the ability
of a pathogenic virus to lie dormant (latent) within a cell. A latent viral infection is a
type of persistent viral infection which is distinguished from a chronic viral infection.
d. Manifest or clinical infection. A clinical infection means one that presents with some
clinical symptoms. It's an infection where the patient has some complaints like fever,
cough etc. A 'subclinical' infection is where the patient is infected with organisms but
doesn't have any symptoms yet.
Contamination: The presence of an infectious agent on a body surface, on or in clothes,

beddings, toys, surgical instruments or dressings, or other articles or substances including
water and food
Infestation: It is the lodgment, development and reproduction of arthropods on the

surface of the body or in the clothing, e.g. lice, itch mite. This term could be also used to
describe the invasion of the gut by parasitic worms, e.g. ascariasis.
Contagious disease: A contagious disease is the one that is transmitted through contact.
Examples include scabies, trachoma, STD and leprosy.
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Vector of infection: An insect or any living carrier that transports an infectious agent from
an infected individual or its wastes to a susceptible individual or its food or immediate
surroundings. Both biological and mechanical transmissions are encountered.
Reservoir: Any person, animal, arthropod, plant, soil, or substance, or a combination of

these, in which an infectious agent normally lives and multiplies, on which it depends
primarily for survival, and where it reproduces itself in such a manner that it can be
transmitted to a susceptible host. It is the natural habitat of the infectious agent.
Incidence and Prevalence of infectious diseases
Incidence of an infectious disease: Number of new cases in a given time period
Prevalence of an infectious disease: Number of cases (old and new) at a given time
Epidemic: “The unusual occurrence in a community of disease, specific health related

behavior, or other health related events clearly in excess of expected occurrence”(epi=
upon; demos= people). Epidemics can occur upon endemic states too.
Endemic: It refers to the constant presence of a disease or infectious agent within a given
geographic area or population group. It is the usual or expected frequency of disease within
a population.(En = in; demos = people)
Pandemic and Exotic:An epidemic usually affecting a large proportion of the population,
occuring over a wide geographic area such as a section of a nation, the entire nation, a
continent or the world, e.g. Influenza pandemics.
Exotic diseases are those which are imported into a country in which they do not otherwise
occur, as for example, rabies in the UK.
Sporadic: The word sporadic means “scattered about”. The cases occur irregularly,
haphazardly from time to time, and generally infrequently. The cases are few and
separated widely in time and place that they show no or little connection with each other,
nor a recognizable common source of infection.
However, a sporadic disease could be the starting point of an epidemic when the conditions
are favorable for its spread.
Nosocomial infections: Nosocomial (hospital acquired) infection is an infection

originating in a patient while in a hospital or another health care facility. It has to be a new
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disorder unrelated to the patient’s primary condition. Examples include infection of
surgical wounds, hepatitis B and urinary tract infetions.
Opportunistic infection: This is infection by organisms that take the opportunity

provided by a defect in host defense (e.g. immunity) to infect the host and thus cause
disease. For example, opportunistic infections are very common in AIDS. Organisms include
Herpes simplex, cytomegalovirus, M. tuberculosis….
Incubation period:This is the time from exposure to development of disease. In other

words, the time interval between invasion by an infectious agent and the appearance of the
first sign or symptom of the disease in question.
Latent period:This is the period between exposure and the onset of infectiousness (this
may be shorter or longer than the incubation period).
A case
A case is defined as “a person in the population or study group identified as having the
particular disease, health disorder, or condition under investigation”
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Chain of Disease Transmission
(III): Susceptible host

An infectious agent seeks a susceptible host aiming “successful parasitism”.
Four stages are required for successful parasitism:
1. Portal of entry
2. Site of election inside the body
3. Portal of exit
4. Survival in external environment
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The six factors involved in the chain of disease transmission are:
A. Infectious agent (etiology or D. Mode of transmission

causative agent) E. Portal of entry
B. Reservoir F. Susceptible host
C. Portal of exit
A. Infectious agent:
An organism that is capable of producing infection or infectious disease.On the basis of

their size, etiological agents are generally classified into:
 Metazoa (multicellular organisms). (eg. Helminths).

 Protozoa (Unicellular organisms) (e.g. Ameobae)
 Bacteria (e.g. Treponema pallidum, Mycobacterium tuberculosis, etc.)
 Fungus (e.g. Candida albicans)
 Virus (e.g. Chickenpox, polio, etc.)
B. Reservoir of infection:
Any person, animal, arthropod, plant, soil or substance (or combination of these) in which
an infectious agent normally lives and multiplies, on which it depends primarily for
survival and where it reproduces itself in
Types of reservoirs
1) Man:There are a number of important pathogens that are specifically adapted to man,
such as: measles, smallpox, typhoid, meningococcal meningitis, gonorrhea and syphilis.
The cycle of transmission is from human to human.
2) Animals: Some infective agents that affect man have their reservoir in animals. The
term “zoonosis” is applied to disease transmission from animals to man under natural
conditions.
For example:
o Bovine tuberculosis - cow to man

o Brucellosis - Cows, pigs and goats to man
o Anthrax - Cattle, sheep, goats, horses to man
o Rabies - Dogs, foxes and other wild animals to man
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o Man is not an essential part (usual reservoir) of the life cycle of the agent.
3) Non-living things as reservoir:
Many of the agents are basically saprophytes living in soil and fully adapted to live freely in
nature. Biologically, they are usually equipped to withstand marked environmental
changes in temperature and humidity. A saprophyte is an organism which gets its energy
from dead and decaying organic matter. This may be decaying pieces of plants or animals.
This means that saprophytes are heterotrophs. They are consumers in the food chain.
Eg.# Clostridium botulinum etiologic agent of Botulism
# Clostridium tetani etiologic agent of Tetanus
C. Portal of exit (mode of escape from the reservoir):

This is the site through which the agent escapes from the reservoir. Examples include:
 GIT: typhoid fever, bacillary dysentery, amoebic dysentery, cholera, ascariasis, etc.
 Respiratory: tuberculosis, common cold, etc.
 Skin and mucus membranes: Syphilis
D. Mode of transmission (mechanism of transmission of infection):
Refers to the mechanisms by which an infectious agent is transferred from one person to
another or from a reservoir to a new host. Transmission may be direct or indirect.
1. Direct transmission: Consists of essentially immediate transfer of infectious agents from
an infected host or reservoir to an appropriate portal of entry. This could be:
 Direct Vertical - Such as: transplacental transmission of syphilis, HIV, etc.
 Direct horizontal - Direct touching, biting, kissing,sexual intercourse, droplet spread
onto the conjunctiva or onto mucus membrane of eye, nose or mouth during
sneezing coughing, spitting or talking; Usually limited to a distance of about one
meter or less.
2. Indirect transmission
 Vehicle - borne transmission: Indirect contact through contaminated inanimate
objects.The vehicle—that is, an inanimate object or material is called in scientific
terms a "fomite". The following are examples of formites
- Bedding, toys, handkerchiefs, soiled clothes, cooking or eating utensils, surgical
instruments.
- Contaminated food and water
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- Biological products like blood, serum, plasma or IV-fluids or any substance serving
as intermediate means by which an infectious agent is transported and introduced
into a susceptible host through a suitable portal of entry. The agent may or may not
multiply or develop in the vehicle before it is introduced into man.
 Vector-borne transmission: Occurs when the infectious agent is conveyed by an
arthropod (insect) to a susceptible host.
- Mechanical transmission: The arthropod transports the agent by soiling its feet or
proboscis, in which case multiplication of the agent in the vector does not occur.
(e.g. common house fly.)
- Biological transmission: This is when the agent multiplies in the arthropod before it
is transmitted, such as the transmission of malaria by mosquito.
 Air-borne transmission: Dissemination of microbial agent by air to a suitable portal
of entry, usually the respiratory tract.
- Two types of particles are implicated in this kind of spread:
o Dust: small infectious particles of widely varying size that may arise from
soil, clothes, bedding or contaminated floors and be re-suspended by air
currents.
o Droplet nuclei: Small residues resulting from evaporation of fluid (droplets
emitted by an infected host). They usually remain suspended in the air for
long periods of time.
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E. Portal of entry:
The site in which the infectious agent enters to the susceptible host. For example:
 Mucus membrane  GIT

 Skin  Blood
 Respiratory tract
F. Susceptible host (host factors):
A person or animal lacking sufficient resistance to a particular pathogenic agent to prevent

disease if or when exposed. Occurrence of infection and its outcome are in part determined
by host factors. The term “immunity” is used to describe the ability of the host to resist
infection. Resistance to infection is determined by non-specific and specific factors:
 Non-specific factors include:

- Skin and mucus membrane
- Mucus, tears, gastric secretion
- Reflex responses such as coughing and sneezing.
 Specific factors
- Genetic-hemoglobin resistant to Plasmodium falciparum that cause malaria in humans
- Naturally acquired or artificially induced immunity. Acquired immunity may be active
or passive.
o Active immunity- acquired following actual infection or immunization.
o Passive immunity- pre-formed antibodies given to the host.
Carriers
A carrier is “an infected person or animal that harbors a specific infectious agent in the
absence of (visible) clinical disease and serves as a potential source of infection to others.
This phenomenon occurs either due to inadequate treatment or immune response, the
disease agent is not completely eliminated, leading to a carrier state.
Types of carriers
 Healthy or asymptomatic carriers: These are persons whose infection remains

unapparent. For example, in poliovirus, meningococcus and hepatitis virus infections,
there is a high carrier rate.
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 Incubatory or precocious carriers: These are individuals or persons who excrete the
pathogen during the incubation period (i.e. before the onset of symptoms or before the
characteristic features of the disease are manifested). E.g. Measles, mumps, chickenpox
and hepatitis
 Convalescent Carriers: These are those who continue to harbor the infective agent after
recovering from the illness. E.g. Diphtheria, Hepatitis B virus.
 Chronic Carriers: The carrier state persists for a long period of time. E.g. Typhoid fever,
Hepatitis B virus infection
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Concepts of Prevention and Control of communicable diseases: Concept of Prevention
Prevention
The goals of medicine are to promote health, to preserve health, to restore health when it is
impaired, and to minimize suffering and distress. These goals are embodied in the word
"prevention"
Prevention; Definition and Concept
Prevention refers to actions aimed at eradicating, eliminating or minimizing the impact of

disease and disability, or if none of these are feasible, retarding the progress of the disease
and disability.
The concept of prevention is best defined in the context of levels, traditionally called
primary, secondary and tertiary prevention. A fourth level, called primordial prevention,
was later added.
Determinants of Prevention
Successful prevention depends upon:

a. a knowledge of causation,
b. dynamics of transmission,
c. identification of risk factors and risk groups,
d. availability of prophylactic or early detection and treatment measures,
e. an organization for applying these measures to appropriate persons or groups, and
f. continuous evaluation of and development of procedures applied
Levels of prevention
Leavell’s Levels of Prevention
Stage of disease Level of prevention Type of response

Pre-disease Primary prevention Health promotion & specific protection
Latent Disease Secondary Pre-symptomatic Diagnosis and treatment
prevention
Symptomatic Tertiary prevention -Disability limitation for early symptomatic
Disease disease
-Rehabilitation for late symptomatic disease
Other levels of prevention
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1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
1. Primordial prevention
Primordial prevention consists of actions and measures that inhibit the emergence of risk
factors in the form of environmental, economic, social, and behavioral conditions and
cultural patterns of living etc.
It is the prevention of the emergence or development of risk factors in countries or

population groups in which they have not yet appeared. For example, many adult health
problems (e.g., obesity, hypertension) have their early origins in childhood, because this is
the time when lifestyles are formed (for example, smoking, eating patterns, physical
exercise).
In primordial prevention, efforts are directed towards discouraging children from adopting
harmful lifestyles
The main intervention in primordial prevention is through individual and mass education
2. Primary prevention
Primary prevention can be defined as the action taken prior to the onset of disease, which
removes the possibility that the disease will ever occur.It signifies intervention in the pre-
pathogenesis phase of a disease or health problem.
Primary prevention may be accomplished by measures of “Health promotion” and “specific

protection”
It includes the concept of "positive health", a concept that encourages achievement and
maintenance of "an acceptable level of health that will enable every individual to lead a
socially and economically productive life".
Primary prevention may be accomplished by measures designed to promote general health

and well-being, and quality of life of people or by specific protective measures.
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Primary prevention
Achieved
by
Specific
Health promotion
protection
Immunization and
Health chemoprophylaxi
seroprophylaxis
education Use
s of specific nutrients or supplementations
Environmental modifications
Protection against occupational hazards
Nutritional
interventions Safety of drugs and
Life style and behavioral changes Control
foods of environmental
hazards,
e.g. air pollution
Health promotion is “the process of enabling people to increase control over the
determinants of health and thereby improve their health”.
Approaches for Primary Prevention
The WHO has recommended the following approaches for the primary prevention of
chronic diseases where the risk factors are established: A.
Population (mass) strategy B. High –risk strategy
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A. Population (mass) strategy: “Population strategy" is directed at the whole population
irrespective of individual risk levels. For example, studies have shown that even a small
reduction in the average blood pressure or serum cholesterol of a population would
produce a large reduction in the incidence of cardiovascular disease. The population
approach is directed towards socio-economic, behavioral and lifestyle changes
B. High -risk strategy: The high -risk strategy aims to bring preventive care to individuals
at special risk. This requires detection of individuals at high risk by the optimum use of
clinical methods.
The objectives of primary prevention are to:

1) Promote health 2) Prevent exposure 3) Prevent disease.
1. Health promotion: This consists of general non-specific interventions that enhance health
and the body’s ability to resist disease, such as measures aimed at the improvement of
socio-economic status through the provision of adequately-paid jobs, education and
vocational training, affordable and adequate housing, clothing, and food, old-age pension
benefits; emotional and social support, relief of stress, etc. In short it is any intervention
that promotes a healthier and happier life.
2.Prevention of exposure:This includes actions such as the provision of safe and adequate
water, proper excreta disposal, vector control, safe environment at home (e.g., proper
storage of insecticides and medicines, out of children’s reach), at school and at work (e.g.,
proper ventilation, monitoring of harmful substances in factories), and on the streets (e.g.,
driver licensing laws).
3. Prevention of disease:-This occurs during the latency period between exposure and the
biological onset of disease. An example for this is immunization. Immunization against an
infectious organism does not prevent it from invading the immunized host, but prevents it
from establishing an infection.
Active immunization means exposing the host to a specific antigen against which it will
manufacture its own protective antibodies after an interval of about three weeks (during
which the immunized person remains susceptible to the disease). For active immunization
to be protective, the timing of its administration must be at least three weeks prior to
exposure.
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Passive immunization means providing the host with the antibodies necessary to fight
against disease.Passive immunization, on the other hand, is commonly given after exposure
has occurred (as in the case of exposure to rabies or tetanus), or shortly before an exposure
is expected, as in the administration of immune globulin to prevent viral hepatitis A).
Both forms of immunization act after exposure.
Breastfeeding is an example of an intervention that acts at all three levels of primary
prevention:
 Health promotion: by providing optimal nutrition for a young child, either as the sole
diet up to four months of age, or as a supplement in later months.
 Prevention of exposure: by reducing exposure of the child to contaminated milk.
 Prevention of disease after exposure: by the provision of anti-infective factors,
including antibodies, white blood cells, and others
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3. Secondary prevention
It is defined as “action which halts the progress of a disease at its incipient stage and
prevents complications.” The specific interventions are: early diagnosis (e.g. screening
tests, and case finding programs….) and adequate treatment.
Secondary prevention attempts to arrest the disease process, restore health by seeking out
unrecognized disease and treating it before irreversible pathological changes take place,
and reverse communicability of infectious diseases.
It thus protects others from in the community from acquiring the infection and thus
provide at once secondary prevention for the infected ones and primary prevention for
their potential contacts.
The objective here is to stop or slow the progression of disease so as to prevent or limit
permanent damage, through the early detection and treatment of disease. (e.g. breast
cancer (prevention of the invasive stage of the disease), trachoma (prevention of
blindness), and syphilis (prevention of tertiary or congenital syphilis
Early diagnosis and treatment
WHO Expert Committee in 1973 defined early detection of health disorders as “ the
detection of disturbances of homoeostatic and compensatory mechanism while
biochemical, morphological and functional changes are still reversible.”
The earlier the disease is diagnosed, and treated the better it is for prognosis of the case
and in the prevention of the occurrence of other secondary cases.
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4. Tertiary prevention
It is used when the disease process has advanced beyond its early stages.After permanent
damage has set in, the objective of tertiary prevention is to limit the impact of that damage.
The impact can be physical, psychological, social (social stigma or avoidance by others),
and financial.
It is defined as “all the measures available to reduce or limit impairments and disabilities,
and to promote the patients’ adjustment to irremediable conditions.”
Intervention that should be accomplished in the stage of tertiary prevention are disability
limitation, and rehabilitation.
Disability limitationDisease >>>>Impairment >>>>Disability>>>> Handicap
Impairment: Impairment is “any loss or abnormality of psychological, physiological or

anatomical structure or function.”
Disability: Disability is “any restriction or lack of ability to perform an activity in the

manner or within the range considered normal for the human being.”
Handicap: Handicap is termed as “a disadvantage for a given individual, resulting from an

impairment or disability, that limits or prevents the fulfillment of a role in the community
that is normal (depending on age, sex, and social and cultural factors) for that individual.”
Rehabilitation: Rehabilitation is “ the combined and coordinated use of medical, social,

educational, and vocational measures for training and retraining the individual to the
highest possible level of functional ability.”
Rehabilitatio
n
Psychologica
Medical Vocational Social
l
rehabilitation rehabilitation rehabilitation
rehabilitation
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Concepts of Communicable Disease Control
The term disease control describes ongoing operations aimed at reducing:
 The incidence of disease
 The duration of disease and consequently the risk of transmission
 The effects of infection, including both the physical and psychosocial complications
 The financial burden to the community.
Control>>>>>>Elimination>>>>>>> Eradication
Control refers to the reduction of the incidence and prevalence of communicable disease to
a level where it cannot be a major public health problem. Control activities focus on
primary prevention or secondary prevention, but most programs combine both.
Methods of Communicable Disease Control

The following are the main methods of controlling communicable diseases:
1) Elimination of the Reservoir
Between control and eradication, an intermediate goal has been described, called "regional
elimination" The term "elimination" is used to describe interruption of transmission of
disease, as for example, elimination of measles, polio and diphtheria from large geographic
regions or areas. Regional elimination is now seen as an important precursor of eradication
a) Man as reservoir:
When man is the reservoir, eradication of an infected host is not a viable option.
Instead, the following options are considered:
 Detection and adequate treatment of cases: arrests the communicability of the
disease (e.g.Treatment of active pulmonary tuberculosis).
 Isolation: separation of infected persons for a period of communicability of the
disease.Isolation is indicated for infectious disease with the following features:
-High morbidity and mortality
-High infectivity
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 Quarantine: limitation of the movement of apparently well person or animal who
has been exposed to the infectious disease for duration of the maximum incubation
period of the disease.
b) Animals as reservoir:
Action will be determined by the usefulness of the animals, how intimately they are
associated to man and the feasibility of protecting susceptible animals.
For example:
- Plague: The rat is regarded as a pest and the objective would be to destroy the
rat and exclude it from human habitation.
- Rabies: Pet dogs can be protected by vaccination but stray dogs are destroyed.
- Infected animals used for food are examined and destroyed.
c) Reservoir in non-living things: Possible to limit man’s exposure to the affected area
(e.g.Soil, water, forest, etc.).
2. Interruption of transmission :
This involves the control of the modes of transmission from the reservoir to the potential
new host through:
- Improvement of environmental sanitation and personal hygiene
- Control of vectors
- Disinfections and sterilization
3. Protection of susceptible host:
This can be achieved through:
- Immunization: Active or Passive
- Chemo-prophylaxis- (e.g Malaria, meningococcal meningitis, etc.)
- Better nutrition
- Personal protection. (e.g.wearing of shoes, use of mosquito bed net, insect
repellents, etc.)
4. Disease Eradication:
Eradication literally means to "tear out by roots". It is the process of “Termination of all
transmission of infection by extermination of the infectious agent through surveillance and
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containment”.Eradication is an absolute process, an "all or none" phenomenon, restricted
to termination of an infection from the whole world. It implies that disease will no longer
occur in a population.To-date, only one disease has been eradicated, that is smallpox.
Key points
 The goals of medicine are to promote health, to preserve health, to restore health when
it is impaired, and to minimize suffering and distress. These goals are embodied in the
word "prevention"
 Successful prevention depends upon a knowledge of causation, dynamics of

transmission, identification of risk factors and risk groups, availability of prophylactic
or early detection and treatment measures, an organization for applying these
measures to appropriate persons or groups, and continuous evaluation of and
development of procedures applied
 The objective of preventive medicine is to intercept or oppose the "cause" and thereby
the disease process. This epidemiological concept permits the inclusion of treatment as
one of the modes of interventions to diseases.
 Nutrition plays an important role in preventing illness and reducing morbidity and
mortality in people living with other infectious diseases
Quiz
1. State the six important factors that involve the chain of communicable diseases
transmission.
2. Describe the three levels of disease prevention.
3. Explain the methods used to control communicable diseases
Communicable diseases common characteristics of importance
1. They are very common 4. Most of them are preventable fairly

2. Some of the cause death and disability simple interventions
3. Some of the cause epidemics 5. Many of the affect infants and children
The Communicable Disease Cycle

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It is important to understand the cycle of communicable diseases.This may help to identify
the individuals that are likely to transmit the disease, as well as those at greatest risk of
becoming ill or dying within the population.
Summary on Principles of Control of Communicable Diseases
The four factors crucial to the spread of communicable diseases include (A) The infective
agent, (B) The source of infection, (C) The mode of transmission and (D) The host.
The control of the spread of communicable diseases should focus on controlling all these
four factors so as to break the chain of infection.
Factors of transmission Control measures

Infective agents Disinfection to kill the infective agents
Source of infection -Early detection, isolation and treatment of patients
-Removal of breeding sites
Mode of transmission -Maintenance of good environmental, personal and food
hygiene
- adoption of infection control measures appropriate to the
different modes of transmission
Host (Sustainable -Building up personal immunity by immunization and
population) healthy lifestyles
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Natural History of disease
The natural history of disease refer to the process of disease/condition progression from
the time it affect an individual to the time the individual recovers or dies if appropriate
measures are not instituted. The process has two distinct periods;
Pre-pathogenesis period: this is the period before the disease infects an individual. The
agent and host are interacting in the environment. At this level the host defense system is
well capable of handling the agent (causative organisms) hence there is no disease.
Pathogenesis period is the period that starts when the body defense mechanism has been
overcome by the agent (disease causing organisms). This result to the host cells dying this
takes various stages;
Sub clinical horizon; the host cells have started dying but to major effects are felt yet and
the host has no signs or symptoms of the disease. At this level only laboratory tests would
reveal the extent of damage.
Clinical horizon; at this time the damage on the cells is so much that some of the hosts
body functions are starting to fail. This manifests in signs and symptoms of a disease that
the host is feeling uncomfortable or sick. If the host does not receive appropriate medical
intervention then thy get in to the next stage.
Early disease stage; at this time the disease effects are real as a result of massive cell
damages that are affecting tissues functions. The host need appropriate intervention to
correct the damage. If they fail to receive correct interventions then the disease gets in to
the next level.
Advanced disease; at this level the damage to the host systems is massive and may be
irreversible leading to disability, or permanent damage. The host has three outcomes at
this stage i.e. recover, permanent disability, convalescence or in worst cases death.
##Communicable diseases are diseases that are as a result of the causative organism
spreading from one person to another or from animals to people. They are among the
major causes of illnesses in Kenya and the entire Africa. These diseases affect people of all
ages but more so children due to their exposure to environmental conditions that support
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the spread. Communicable diseases are preventable base on interventions placed on
various levels of transmission of the disease.
New and emerging diseases are challenging public health as never before. Unfortunately,
many of these diseases affect the poor and marginalized sections of society, and contribute
not only to ill health and poverty at micro-level but also have serious socio-economic
implications at the macro-level.
Health workers have an important role to play in the control of these diseases by applying
effective and efficient management, prevention and control measures. Health workers need
to be equipped with capacity to target communicable diseases for eradication.
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BASIC EPIDEMIOLOGY
Epidemiology is the study of distribution and determinants of disease and conditions among
populations. In the past, epidemiology was concerned exclusively with studying the nature
of infectious diseases, the causes and conditions of their origin, their spread in human
populations as well as the methods of preventing, controlling and eliminating them.
Epidemiological methods are increasingly playing an important role in the study of the
incidence and distribution of non-infectious (non-communicable disease) diseases, the
health status on population factors related to the origin and spread of those diseases and
factors that can help to maintain and restore health.
Disease distribution is considered in terms of Persons, time and place (Who, when and
where). Persons who are affected by disease in terms of age, sex, race, occupation etc. The
common characteristics relating to those persons affected by disease.
Time relates to when the diseases is most likely to strike e.g. an epidemic, endemic,
seasonal, cyclic etc
Place refer to the geographical distribution of a diseases and the common characteristics
that are favourable for that diseases in the given locality. Some diseases are localized,
regional, pandemic etc
Disease determinant factors
The causative factors of disease are agent, host, and environment. These three factors are
referred as epidemiological triad. The mere presence of these factors is not sufficient to
initiate a disease. An interaction of all these three factors is necessary for individuals to be
affected. In pre-pathogenesis phase, the disease agent is already present but it has not
entered man. The next phase is the Pathogenesis: this phase begins with the entry of
disease agent into man. There are certain interval of time before the onset of clinical signs
and symptoms of the disease.
Epidemiological triad
26
27
Agent refers to the disease causing organism characteristics e.g. habitation, breeding
migration, infectivity, climatic and environmental factors favouring its existence.
Host refers to the biological makeup of the individuals that make the vulnerable to the
specified illness e.g. physical condition, genetic makeup, habits etc.
Environment refers to the ecological conditions that favour the interaction of host and
agent e.g. swampy areas, bushes within households, sanitation etc.
Control and prevention measures can be implemented at the various levels of the chains
shown above.
For example:
 To break the chain between host and environment for malaria disease you need to clear
swampy areas, bushes and proper disposal of waste.
 To break the chain between host and agent in malaria disease one can take prophylactic
anti-malaria drugs.
 To break the chain between the environment and the agent one can spray the breeding
sites for mosquitoes and for the vector and host chain one can sleep under mosquito
net.
Vector is a vehicle that some of the agents or disease causing organism require to be move
from one point to the other, some require it to complete their developmental cycle e.g. a
mosquito in transmission of malaria. Not all communicable diseases require a vector for
transmission.
Measures of disease in populations: Epidemiologists use various methods and

approaches in quantifying disease cases in a population such as; *counts, *ratio,
*proportion, *percentage, and *rates.
How to determine endemic and epidemic diseases

Commonly used rates: Crude birth rate, Fertility rate. Measures of morbidity and mortality:
Crude death rate, Specific death rate, Cause specific death rate, Infant mortality rate,
28
Neonatal mortality rate, Post neonatal mortality rate
(Students to make Reference to their epidemiology notes)
29
Epidemiological methods
Epidemiologic methods are the various approaches in which data is gathered analyzed and
reports written with regard to various diseases distribution and determinants. They enable
us to plan and evaluate disease management in communities.
They are several classified as:
A. Descriptive methods e.g. Individual based (case study and case series)
B. Population based (correlation studies, cross sectionals studies and surveys)
C. Analytical studies e.g. prospective (cohort studies) and retrospective (case control)
D. Experimental studies
E. Community based studies e.g. community trials
A. Descriptive studies
These are basic studies that seek to describe the situation as it is. These methods utilize
simple descriptive statistics such as percentages tables and graphs to describe the disease
situation. These studies generate hypothesis.
a. Individual based studies; they reflect on single individuals as the unit of study
Case report – a single unique case is reported as it is identified by the health worker.
Case series- several case reports that have similar characteristics are analyzed so as to
draw conclusions in relation to the particular disease of interest.
B. Population based studies

a. Surveys – are conducted over a short duration of time with specific objectives to meet.
They are more of fact finding studies in a bid to rapidly draw conclusion with regard to
illnesses or conditions affecting entire population.
b. Cross sectional studies- these are studies carried out across a huge population sample
over a very short duration of time. Their methodology and analysis is more advanced
than that of surveys.
c. Correlation studies- These studies seek to compare one variable or characteristic of
population to one or more others. E.g. smoking and lung disease, immunization
coverage and measles outbreaks. One may also compare worm infestation against use
of latrines, amount of house hold water, maternal literacy etc.
30
C. Analytical studies
These studies are more advanced in methodology and analysis and their findings are more
generalisable as compared to descriptive studies. While descriptive studies generate
hypothesis these ones test hypothesis.
a). Prospective studies (Cohort studies): These studies start with individuals with an
exposure of interest (cohorts) and are followed up over time as they are compared with
individuals who do not have the exposure of interest. Analysis is then done to find out if
those who had exposure will develop the outcome of interest more that those without
exposure.
Example: People working in farms (exposed to zoonotic disease) are followed up over time
to establish if they will manifest the zonnotic diseases. Simultaneously a similar group of
individuals who do not work in the farms are followed up to establish if they develop
zoonotic disease.
b). Retrospective (case control studies) These studies are easier to conduct consume less
time and are cheaper than the cohort studies. Two groups are selected from a population
one group with the disease of interest (case) and another without (control). Then they are
asked about their past in order to establish if they had a common exposure that might have
caused the disease. These studies are however prone to recall biases.
Example: In a community people who have amoebiasis may be asked about their food
(sources, preparation, storage and consumption) they have been consuming. Another
group from same community who do not suffer from amebiasis is also asked the same
questions then the data is analyzed.
D. Experimental studies
These are studies conducted in a controlled environment where the researcher has control
over all variables. It is a laboratory set up kind of study. They are very useful in isolation of
the actual disease causative agent. They are very strict and also very expensive. They
require highly specialized personnel and equipment.
E. Community based studies

A. Community trials: These are studies involving. They involve the entire community.
Example: In one community water may be fluoridate while in the other it may not. The two
are followed up and with time if those taking water that is not fluoridated start
31
complaining of teeth problem then the effects of fluoride are confirmed.
Disease surveillance
Health Surveillance may be defined as the tracking and forecasting of any health event or
healthdeterminant through the; Continuous collection of high-quality data, Integration,
analysis and interpretation of those data into surveillance products (for example reports,
advisories, alerts, and warnings), Dissemination of those surveillance products to those
who need to know.
Surveillance products are produced for a specific public health purpose or policy objective.
Surveillance should be purposeful, economical, and action oriented. It should not only
detect emerging health risks, but include systems that allow public health officials to
monitor and evaluate progress in health protection and disease prevention.
New health risks such as bioterrorism and zoonoses, re-emergence of some diseases (e.g.,
multiresistant bacteria), and globalization have fundamentally altered the scope and
response time expected of surveillance programs at every level. Surveillance uses whatever
data sources will provide the necessary information.
Surveillance systems may share data with personal health services information systems,
but the end-products are different. Most of the data currently available from health
facilities are originally generated for administrative purposes. They can serve as raw
material for health services management and research, as well as for disease and health
surveillance if procedures for capturing and handling administrative data are appropriately
adapted.
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Sources of surveillance data
In general, surveillance data can originate from any of four classes of source:
Special purpose: i.e., data collected specifically for a particular surveillance need. Special
purpose data sources select the most relevant data and facilitate detection and response,
but are costly to operate and may be difficult to maintain over the long term.
Surveys: Usually collected for more general health surveillance purposes, survey data
differ from other special purpose data sets in that they are usually cross-sectional or 'one-
off' and may be useful for multiple surveillance functions.
Administrative: As noted, data collected for administrative purposes often find a

secondary purpose in disease surveillance, e.g., analysis of the diagnostic fields on hospital
discharge abstracts looking for geographic clusters of a particular disease. Administrative
data are generally lower quality, and may not always be available on a timely basis, but are
convenient to acquire and inexpensive.
Clinical: For many surveillance purposes, this is the ideal source. Indeed, new diseases and
emerging clusters of known diseases are often first suspected by intelligent clinicians who
observe unusual patterns of illness, and work with others to initiate more systematic
surveillance. Optimum efficiency in clinical surveillance can only be achieved if the clinical
data are accessible electronically. This is rarely the case at present. The Electronic Health
Record has the potential to be a rich source of surveillance data in future. Moreover, as
submissions to the Committee have pointed out, clinical data for surveillance need to be
assembled from a range of providers and facilities, including family physicians and other
primary care providers, emergency departments, pharmacists, and veterinarians.
Effective Communicable diseases control relies on an effective surveillance and response

system that promote better coordination and integration of surveillance function.
In 1998 WHO/AFRO, following the resolution of the 48th assembly started promoting
Integrated Disease Surveillance and Response (IDSR) for all member state to adopt as the
main strategy to strengthen national disease surveillance system.
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Integrated disease surveillance and response (IDSR)
The specific goals of IDSR are to:
 Strengthen district level surveillance and response for priority diseases,
 Integrate laboratory with laboratory support,
 Reduce duplication in reporting,
 Share resources among disease control programs,
Basic ingredients:
 A good network of motivated people,
 Clear case definition and reporting mechanism,
 Efficient communication system,
 Basic but sound epidemiology,
 Laboratory support,
 Good feedback and rapid response:
Translate surveillance and laboratory data into specific and timely public health
actions
Integrated disease surveillance predicts all surveillance activities in a country as a common

public service that carry out many functions using similar structures, processes and
personnel. The surveillance activities that are well developed in one area may act as driving
forces for strengthening other surveillance activities, offering possible synergies and
common resources.
Surveillance is based on collecting only the information that is required to achieve

objectives for disease control. Data requested may differ from disease to disease and some
diseases may have specific information needs, requiring specialized systems.
With the global momentum to scale up response to communicable diseases, public health
practitioners need to review constantly their performance in detecting and responding to
communicable diseases.
Notifiable diseases
Notification of communicable diseases means informing the health authorities that a

patient or person is suspected to be suffering or is actually suffering from an infectious
34
disease. After being notified, the authorities take the necessary measures to control th
disease
In Kenya according to the public health act cap 254 ; 17(1) there are diseases that should
be notified to the higher authorities above your office as a health worker once you come
across them. They include;
1. Smallpox, 5. Typhus fever, 10. Glanders,

2. Plague, 6. Whooping cough, 11. Rabies,
3. Cholera, 7. Acute polio-myelitis, 12. Malta fever,
4. Scarlatina Or Scarlet 8. Leprosy, 13. Beri-beri,
Fever, 9. Anthrax,
14. Erysipelas, puerperal fever (including septicaemia, pyasmia, septic pelvic cellulitis or
other serious septic condition occurring during the puerperal state),
15. Enteric or typhoid fever (including para-typhoid fever),
16. Epidemic cerebro-spinal meningitis or cerebro-spinal fever,
17. Sleeping sickness or human trypanosomiasis,
18. Diphtheria or membranous croup measles,
19. Yaws and all forms of tuberculosis which are clinically recognizable apart from reaction
to the tuberculin test.
Some of the diseases are notifiable locally to the Medical Office of Health and others to both
the medical officer of health and the world Health Organization.
Diseases notifiable to the MOH on a weekly basis are Amoebiasis, schistomiasis (bilharzia),
ancylostoma (hookworms), brucellosis, dysentery, encephalitis and filariasis.
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Importance of epidemiology in communicable diseases control
A. General Role of epidemiology in Health

1) Community Diagnosis
In community Diagnosis, the type and size of problems are described and indications given
to the community. This information is important to the government because it helps in
planning health services, in estimating future needs, determinant health priorities and
evaluating health service activities
2) Projection of health problems
These have to be established and facilities made available. That means accurate data on the
current health status of the population and expected trends in prevalence and distribution
of the major causes of illness and death. It is only through epidemiological methods that
such information can be provided.
3) Research
Research is conducted in order to identify factors contributing to the origin, maintenance
and spread of “New” infectious and noninfectious diseases. The two are studied with the
ultimate goal of providing suitable control measures and determining effective preventive
action.
B. The Specific Role of Epidemiology

1) Directing the surveillance operations toobtain, tabulate and review data selected on
the basis of reports on disease, surveys and special studies, birth and death, reports of
public and private laboratories, investigation of epidemics, cases and contacts and
health organization e.g. schools, industries, hospitals.
2) Calculating rates, ratios and proportions to show the incidence and distribution of
mortality, immunization coverage and health factors.
3) Improving the health information system through systematic analysis, identification
of problems, recommendations for solutions and implementation of recommendations.
4) Making a quick account of cases when an epidemic is suspected. It makes a plan and
programme to interview notified and suspected cases by doctors, health personnel and
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the community to determine the probable number of cases and identify the population
at risk. Prevalence and incidence rates are also calculated using the data obtained.
5) Confirming or ruling out the diagnosis of actual cases and suspected cases to make
sure that all the cases and contacts are identified to organize activities aimed at
identifying the causative agent and determine whether any success is achieved to
established to ensure that serological methods and proper diagnostic tests are being
utilized and to establish criteria for defining a case and make sure known and suspected
cases are analysed.
6) Determining whether there is a true epidemic situation or not by calculating the
rates and comparing these rates with those which would correspond to an epidemic.
7) Determining the necessary data that characterize an epidemic using
epidemiological methods-descriptive, analytical and experimental. It is also used in
selecting and in obtaining the necessary specimens for laboratory tests in interviewing
cases and in acquiring other necessary data e.g. climate, demography, types of soil,
sanitation, routes of communication among others.
8) Data processing: This entails the preparation of tables, graphs, diagrams, maps, and
calculation of rates, ratios, proportions and maps showing distribution of cases to
construct an epidemic curve.
9) Data analysis: These interpret the epidemic curve, mode of transmission, determining
groups at risk in terms of time, person, place and incubation periods for those cases
detected and exposed for a short time.
10)Formulation of hypothesis on original source, duration of exposure and mode of
transmission: This shows the most likely reservoir, causative agent, mode of
transmission, vector agent, route of exit from the reservoir and port of entry into the
susceptible host. An explanatory report is also prepared on the facts which in addition
indicate the most probable source and mechanism of transmission.
11)Testing the hypotheses: In this process additional data is obtained to confirm the
exposure of the cases to the indicated sources and to verify the mode of transmission.
The specimens of the indicated source confirm its identity by isolating the agent from
the case.
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12)Identification of the recommendations to control the problem by laying down
procedures to eliminate or control the source, to prevent exposure of the susceptible
subjects to the source, to convert susceptible subjects into immune subjects and
indicate the appropriate treatment for cases, contact and carriers.
13)Evaluation of the effectiveness of the control measures by getting specimens for
laboratory tests, carrying out inspections, evaluating the procedure for handling cases
controlling the source and continuing with intensive surveillance operations.
14)Writing a report on the epidemic: The report summarizes all relevant data obtained
and enumerates the various interpretations made. The report describes the measures
taken, indicates the degree of the effectiveness of control measures, and explains the
results obtained and the measurers necessary to improve the control and surveillance
operations.
15)Evaluation: This involves collecting the relevant data through routine reports, using
direct or indirect health problem indicators e.g. incidence and prevalence of a disease
for which control activities have been organized.
There may be organized ad hoc surveys of population to measure absence/ presence of
indicators of programme efficiency.
 Enables us to know the disease distribution patterns
 Enables us to know the disease causation factors
 It equips us with data that we can apply for effective prevention and control of diseases
 It enable us to understand the disease progression and what measures need to be take
to halt or reduces disease effects
 It enables us to evaluate intervention programs
 It enables us to conduct research with regard to communicable diseases and how they
affect populations.
 Incidence rates help us to know how fast the disease is spreading, infecting or affecting
people
 Prevalence rates help us to know how many people are having a disease in the
population
 Prevalence can also give an indication of how fast people are recovering, dying from the
disease and how many are in chronic stage of the disease.
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With this knowledge you can be able to interpreter and predict disease epidemiologic
patterns and hence plan for interventions. You can determine if a disease is an epidemic or
endemic.
Classification of communicable disease
There are various ways of classifying communicable diseases; the classification below is
the one that is considered to be best for ease of understanding.
a. Diseases caused by Faecal – oral contamination e.g acute gastro-enteritis, bacillary

dysentery, campylobacter jejuni, giadiasis, amoebiasis, cholera, enteric fevers, food
poisoning, poliomyelitis, viral hepatitis.
b. Contact diseases e.g. scabies, pediculosis, bedbugs, fleas, flies, fungal skin infections,
trachoma, acute bacterial conjuctivities. Sexually transmitted diseases and HIV/AIDS
c. Vector borne diseases e.g. relapsing fever, bancroftian filariasisn onchocerciasis,
yellow fever, trypanosomiasis, plague, schistosomiasis, dracunculosis, leishmaniasis)
and Malaria.
d. Helmonthic diseases e.g. Ascariaris, enterobiasis, trichuriasis, hookworm,
strongyloidiasis, taeniasis, hydatidosis
e. Airborne diseases; Acute respiratory infections, Meningitis (bacterial and fungal)
Tuberculosis and leprosy.
f. Zoonotic diseases (diseases of contact with animals or animal products) e.g. anthax,
brucellosis, rabies, hydatidosis, tetanus.
Concepts of Prevention and Control
Prevention
The goals of medicine are to promote health, to preserve health, to restore health when it is
impaired, and to minimize suffering and distress. These goals are embodied in the word
"prevention"
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Prevention; Definition and Concept
Prevention refers to actions aimed at eradicating, eliminating or minimizing the impact of

disease and disability, or if none of these are feasible, retarding the progress of the disease
and disability.
The concept of prevention is best defined in the context of levels, traditionally called
primary, secondary and tertiary prevention. A fourth level, called primordial prevention,
was later added.
Determinants of Prevention
Successful prevention depends upon:
g. a knowledge of causation,
h. dynamics of transmission,
i. identification of risk factors and risk groups,
j. availability of prophylactic or early detection and treatment measures,
k. an organization for applying these measures to appropriate persons or groups, and
l. continuous evaluation of and development of procedures applied
Preventable Causes of Disease
They can be summarized by the acronym BEINGS. This stands for;
Biological factors and Behavioral Factors
Environmental factors
Immunologic factors
Nutritional factors
Genetic factors
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Services, Social factors, and Spiritual factors
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Leavell’s Levels of Prevention
Stage of disease Level of prevention Type of response

Pre-disease Primary prevention Health promotion & specific protection
Latent Disease Secondary Pre-symptomatic Diagnosis and treatment
prevention
Symptomatic Disease Tertiary prevention -Disability limitation for early symptomatic
disease
-Rehabilitation for late symptomatic disease
Levels of prevention
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Primordial prevention
Primordial prevention consists of actions and measures that inhibit the emergence of
risk factors in the form of environmental, economic, social, and behavioral conditions
and cultural patterns of living etc.
It is the prevention of the emergence or development of risk factors in countries or

population groups in which they have not yet appeared
For example, many adult health problems (e.g., obesity, hypertension) have their early
origins in childhood, because this is the time when lifestyles are formed (for example,
smoking, eating patterns, physical exercise).
In primordial prevention, efforts are directed towards discouraging children from

adopting harmful lifestyles
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The main intervention in primordial prevention is through individual and mass
education
Primary prevention
Primary prevention can be defined as the action taken prior to the onset of disease,
which removes the possibility that the disease will ever occur.
It signifies intervention in the pre-pathogenesis phase of a disease or health problem.
Primary prevention may be accomplished by measures of “Health promotion” and

“specific protection”
It includes the concept of "positive health", a concept that encourages achievement and
maintenance of "an acceptable level of health that will enable every individual to lead a
socially and economically productive life".
Primary prevention may be accomplished by measures designed to promote general

health and well-being, and quality of life of people or by specific protective measures.
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Primary prevention
Achieved by
Specific
Health promotion
protection
Immunization and seroprophylaxis

Health education chemoprophylaxis
Use of specific nutrients or supplementations
Environmental modifications
Protection against occupational hazards
Nutritional interventions
Safety of drugs and foods
Life style and behavioral changes Control of environmental hazards,
e.g. air pollution
Health promotion
Health promotion is “the process of enabling people to increase control over the
determinants of health and thereby improve their health”.
Approaches for Primary Prevention
The WHO has recommended the following approaches for the primary prevention of
chronic diseases where the risk factors are established:
a. Population (mass) strategy
b. High -risk strategy
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Population (mass) strategy
“Population strategy" is directed at the whole population irrespective of individual risk

levels. For example, studies have shown that even a small reduction in the average blood
pressure or serum cholesterol of a population would produce a large reduction in the
incidence of cardiovascular disease.
The population approach is directed towards socio-economic, behavioral and lifestyle

changes
High -risk strategy
The high -risk strategy aims to bring preventive care to individuals at special risk. This
requires detection of individuals at high risk by the optimum use of clinical methods.
Secondary prevention
It is defined as “action which halts the progress of a disease at its incipient stage and
prevents complications.” The specific interventions are: early diagnosis (e.g. screening
tests, and case finding programs….) and adequate treatment.
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Early diagnosis and treatment
WHO Expert Committee in 1973 defined early detection of health disorders as “ the
detection of disturbances of homoeostatic and compensatory mechanism while
biochemical, morphological and functional changes are still reversible.”
The earlier the disease is diagnosed, and treated the better it is for prognosis of the case
and in the prevention of the occurrence of other secondary cases.
Tertiary prevention
It is used when the disease process has advanced beyond its early stages. It is defined as
“all the measures available to reduce or limit impairments and disabilities, and to promote
the patients’ adjustment to irremediable conditions.”
Intervention that should be accomplished in the stage of tertiary prevention are disability
limitation, and rehabilitation.
Disability limitation
disease
impairment
disability
handica
p
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Impairment: Impairment is “any loss or abnormality of psychological, physiological or
anatomical structure or function.”
Disability: Disability is “any restriction or lack of ability to perform an activity in the

manner or within the range considered normal for the human being.”
Handicap: Handicap is termed as “a disadvantage for a given individual, resulting from an

impairment or disability, that limits or prevents the fulfillment of a role in the community
that is normal (depending on age, sex, and social and cultural factors) for that individual.”
Rehabilitation: Rehabilitation is “ the combined and coordinated use of medical, social,

educational, and vocational measures for training and retraining the individual to the
highest possible level of functional ability.”
Rehabilitatio
n
Psychologica
Medical Vocational Social
l
rehabilitation rehabilitation rehabilitation
rehabilitation
(II) Control
Concept of control:
The term disease control describes ongoing operations aimed at reducing:
The incidence of disease
The duration of disease and consequently the risk of transmission
The effects of infection, including both the physical and psychosocial

complications
The financial burden to the community.
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Control activities focus on primary prevention or secondary prevention, but most
programs combine both.
control
elimination
eradication
Disease Elimination
Between control and eradication, an intermediate goal has been described, called
"regional elimination"
The term "elimination" is used to describe interruption of transmission of disease,

as for example, elimination of measles, polio and diphtheria from large geographic
regions or areas
Regional elimination is now seen as an important precursor of eradication
Disease Eradication
Eradication literally means to "tear out by roots".
It is the process of “Termination of all transmission of infection by extermination of

the infectious agent through surveillance and containment”.
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Eradication is an absolute process, an "all or none" phenomenon, restricted to
termination of an infection from the whole world. It implies that disease will no
longer occur in a population.
To-date, only one disease has been eradicated, that is smallpox.
Monitoring
Monitoring is "the performance and analysis of routine measurements aimed at

detecting changes in the environment or health status of population" (Thus we have
monitoring of air pollution, water quality, growth and nutritional status, etc).
It also refers to on -going measurement of performance of a health service or a

health professional, or of the extent to which patients comply with or adhere to
advice from health professionals.
Objectives of Surveillance
The main objectives of surveillance are:
to provide information about new and changing trends in the health status of a
population, e.g., morbidity, mortality, nutritional status or other indicators and
environmental hazards, health practices and other factors that may affect health
(b) to provide feed-back which may be expected to modify the policy and the
system itself and lead to redefinition of objectives, and
(c) provide timely warning of public health disasters so that interventions

can be mobilized.
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Control of infectious diseases (the 4 “C”s
Contro
l
Cases Contacts Carriers Community
Diagnosis
notification
isolation observation detection Epidemiological
Investigation &
disinfection
treatment containment
follow up
release
Evaluation of control
Evaluation is the process by which results are compared with the intended
objectives, or more simply the assessment of how well a program is performing.
Evaluation should always be considered during the planning and implementation

stages of a program or activity.
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Evaluation may be crucial in identifying the health benefits derived (impact on
morbidity, mortality, sequelae, patient satisfaction).
Evaluation can be useful inidentifying performance difficulties.
Evaluation studies may also be carried out to generate information for other
purposes, e.g., to attract attention to a problem, extension of control activities,
training and patient management, etc.
To summarize
The goals of medicine are to promote health, to preserve health, to restore health
when it is impaired, and to minimize suffering and distress.
These goals are embodied in the word "prevention"
Successful prevention depends upon a knowledge of causation, dynamics of

transmission, identification of risk factors and risk groups, availability of
prophylactic or early detection and treatment measures, an organization for
applying these measures to appropriate persons or groups, and continuous
evaluation of and development of procedures applied
The objective of preventive medicine is to intercept or oppose the "cause" and

thereby the disease process. This epidemiological concept permits the inclusion of
treatment as one of the modes of intervention
Quiz
Match the following statements. Each option may be selected once, more than
once, or not at all:
(a) performing carotid endarterectomy in a patient with transient ischemic

attack
Page 51 of 147
(b) recommending regular physical activity to a patient with no known
medical problem
(C) vaccinating a health care worker against hepatitis B
(d) giving isoniazid for 1 yr to a 28-year-old medical student with a positive

PPD tuberculin skin test.
1. primary prevention 2. secondary prevention
3. tertiary prevention 4. health promotion
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A. Faeco-Orally Transmitted Diseases
Introduction
Faeco-orally transmitted diseases are diseases in which the infectious agents are found
in faeces (stool) and enter the body through the mouth (oral route). The mode of
transmission may be in contaminated food or water, on the hands, or on objects such as
bowls, spoons and cups. These diseases are also referred to as faeco-oral diseases.
Classification of faeco-oral diseases and their infectious agents
Faeco-oral diseases can be caused by a wide range of infectious agents, including bacteria,
viruses, protozoa (single-celled parasites) and helminths (parasitic worms). All human
parasites, whether they are single-celled or many-celled, live inside the human body: some
are harmless, but others cause disease. Poliomyelitis (polio) is a viral faeco-orally
transmitted disease.
Common faeco-orally transmitted diseases and their causal infectious agents.
Faeco-oral disease Infectious agent

Bacteria:
Cholera Vibrio cholerae
Shigellosis (bacillary dysentery) Shigella species
Typhoid fever Salmonella typhii
Viruses:
Viral diarrhoeal diseases Rotavirus (most cases)
Amoebiasis (Amoebiasis is pronounced Entamoeba hystolica
‘am-mee-bya-sis’) (amoebic dysentery)
Giardiasis (giardiasis is ‘jee-arr-dya-sis’) Giardia intestinalis
Helminths:
Ascariasis (ascariasis is ‘ass-kar-rya-sis’) Ascaris lumbricoides
Hookworm Necator americanus or Ankylostoma
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duodenalis
Taeniasis (taeniasis is ‘tee-nya-sis’) Taenia saginata (most cases)
m(tapeworm)
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Direct and indirect faeco-oral transmission
Faeco-oral transmission means ‘from faeces to mouth’. The route can either be:
1. Direct transmission from contaminated hands touching the mouth and transferring
the infectious agents directly; A person’s hands become contaminated with faeces in
several ways, including:
 Using the toilet and not washing the hands afterwards

 Cleaning a child’s bottom after defaecation
 Shaking hands with someone whose hand is already contaminated. Contaminated
hands can easily transmit infectious agents directly to the mouth.
 When flies rest on the hand after they have crawled on faeces
 Accidentally touching faeces in the soil where people or animals have defaecated in
the open fields.
2. Indirect transmission through consumption of food or water, or using utensils,
contaminated with the infectious agents.
Faeces can also contaminate food or water, indirectly transmitting the infectious agents
when a person eats the food, or drinks the water, or some gets into the mouth during
washing. Diseases transmitted indirectly by food or water are called foodborne
diseases and waterborne diseases respectively.
Food could become contaminated with faeces in several ways, including:
 Contaminated hands touching food during preparation or eating

 Using contaminated water to prepare food (e.g. washing fruit)
 Using contaminated utensils (knife, spoon, bowl, etc.) to prepare or eat food
 Feeding a baby with contaminated milk, or using a contaminated bottle
 Flies resting on food after crawling over faeces
 Serving inadequately cooked fruit and vegetables grown in soil contaminated with
faeces.
Water become contaminated with faeces in several ways, including:
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 Sources of water (streams, wells, etc.) can be contaminated with faeces washed out
of the soil by heavy rain if people defaecate in open fields, or in poorly constructed
latrines
 Hands or utensils for eating or drinking may be washed in contaminated water
 Contaminated containers may be used to fetch or store water.
The figure (f-diagram) below illustrates the different ways that faeco-oral transmission can
occur via the six Fs:
1. Food, 3. Flies, 5. Faeces

2. Fingers, 4. Fluids, 6. Fomites
What is the F Diagram?
The famous f-diagram, demonstrates the major transmission routes of faecal-oral
diseases. It illustrates the different routes that the microbes of diarrhoea take from faeces,
through the environment, to a new person.
For example; microbes in faeces on the ground by a well can get into the water system and
be drunk by a child, hands that have not been washed after going to the toilet can carry
microbes onto foods, which are then eaten, infecting another child, who gets diarrhoea and
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spreads more microbes.
The most common steps are:
 Water That Has Come Into Contact With Faeces And Is Then Inadequately Treated
Before Drinking;
 Food That Has Been Handled With Faeces Present;
 Poor Sewage Treatment Along With Disease Vectors Like Houseflies;
 Poor or absent cleaning after handling faeces or anything that has been in contact with
it
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Key practices designed to prevent diarrhoeal infection and break the transmission
route:
Safe disposal of Faeces
Faeces in the public and domestic environment are the primary source of diarrhoeal
pathogens. Safe disposal of stools is the best way to prevent infection. Ideally adult and
child stools should be disposed of in toilets or latrines. In places where this is not possible,
stools should be buried
Hand washing
Hands readily become contaminated with faecal material after going to the toilet or
cleaning children’s bottoms. Rinsing fingers with water alone is not enough. Hands need to
be well washed after contact with faeces; either rubbed with an abrasive such as ash or
mud, or with a detergent such as soap.
Keeping water clean
A plentiful and accessible water supply makes hand washing and cleaning easier, which
helps to keep the environment free of pathogens. Ensuring that faecal material does not get
into water supplies at the source is probably far more effective than boiling, filtering, and
covering water jars.
Fly control
Though flies can carry microbes from faeces to food, fly control is difficult to achieve. If
stools are disposed of in toilets or latrines and these latrines have covers, then fly-based
disease transmission will be minimised.
Food hygiene
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Poor food handling practices contribute to diarrhoeal infection largely because they offer
bacterial pathogens the opportunity to multiply. This way people can consume much
greater doses of microbes. Diarrhoeas often peak in warm, humid seasons in the tropics,
when conditions are favourable to the multiplication of bacteria on food.
Feeding bottles are especially dangerous because they are hard to sterilise and bacteria
grow quickly in warm milk.
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Ways to prevent faecal contamination of hands
A Wash hands with soap and clean water:

A1 After defaecation, or cleaning the bottom of a child, or changing an infant’s nappy
(diaper).
A2 After working with soil, or after children have been playing on soil, where there
has been open defaecation by people or animals.
A3 Before preparing food or eating.
B Cut fingernails and avoid putting fingers into the mouth.
Ways to prevent contamination from unsafe food
C Prepare and eat food safely:

C1 Observe thorough hand hygiene before and during any contact with food
C2 Ensure that all utensils are completely clean; allow them to ‘air dry’ after washing
(don’t wipe with a cloth)
C3 Wash raw vegetables and fruits thoroughly in clean water
C4 Cook other food items thoroughly, particularly meat and fish
C5 Eat cooked food while it is hot and reheat food thoroughly if it has cooled
C6 Cover food so it cannot be exposed to flies.
D Promote exclusive breastfeeding of infants under six months old:
D If babies or young children are fed animal milk or formula, the bottle and teat, or
1 cup and spoon, should be thoroughly washed with clean water and soap before
every feed
D Animal milk should be boiled and cooled before drinking
2
D Formula milk should be mixed with boiled cooled water.
3
E Control flies:
E1 Cover food to prevent contamination by flies
E2 Dispose of faeces and other wastes safely, so flies cannot land on sewage.
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Ways to prevent contamination from unsafe water
F Protect water sources from contamination with faeces:

F1 Use a properly constructed latrine and safe disposal of faeces
F2 Avoid open defaecation in the fields
F3 Avoid direct contact of hands with drinking water
F4 Install protected water sources, such as covered wells with pumps
G Boil water before drinking, or using in preparation of food or fluids
H Use clean drinking cups and clean covered containers for storing water.
QUIZ: Use the letters assigned to each measure to indicate your answers
Which of the measures described above will help to prevent the transmission of infectious
agents by flies?
Measures C6, E1, E2, F1 and F2 will all reduce the risk of faeco-oral diseases
transmitted by flies.
Which of the measures described above are most important when preparing milk for
feeding to young children?
Measures A1, A2, A3, B, C1, C2, D1, D2, D3, G and H.
Why do we need to worry about Faeces
In simple terms, the average faeces can contain 10,000,000 viruses and 1,000,000 bacteria
What diseases can you get via the fecal-oral route?
 Cholera
 Poliomyelitis
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 Typhoid Fever
 Hepatitis A and E
 Shigellosis
1) Diarrhoea
Diarrhoea occurs when stools contain more water than normal, and are loose or watery. In
many regions diarrhoea is defined as three or more loose or watery stools in a 24-hour
period. Children between the ages of 6 months and 2 years often have diarrhoea. It is more
common in settings of poor sanitation and hygiene, including a lack of safe drinking water.
Causative Agents
Viruses such as retro viruses, myxoviruses; bacteria such as salmonella; fungi; parasites
such as Gardia, stronglyloides and other infections like otitis media, measles, broncho-
pneumonia.
Incubation Period
This can take a few hours to three days.
Occurrence
It is universal in distribution. 2,195 Children die daily of diarrhea more than AIDS, malaria
and measles combined – that’s like losing nearly 32 school buses full of children each day.
Diarrhea diseases accounts for 1 in 9 child deaths worldwide, making diarrhea the second
leading cause of death among children under the age of 5 years. For children with HIV,
diearrhoea is even more deadly; the death rate for these children is 11 times higher than
the rate for children without HIV. About 45% of the children in the world die from
diarrhea-associated diseases. Anybody can get diarrhea.
Susceptibility
All people are susceptible although babies and children are at a much higher risk.
Mode of transmission
Infection is acquired through man, animal, flies, faeces and refuse. All unhygienic practices
encourage infection. The organisms are ingested through food, water and milk.
Contamination occurs due to poor hand washing habits when feeding, eating, preparing
and serving food. Contamination also occurs due to poor water and refuses disposal
methods. Raw and improperly cooked foods may also be a source of infection as they can
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cause indigestion, leading to diarrhea. Diarrhea may be associated with other diseases like
cholera, shigella dysentery, typhoid and amoebiasis. Bottle feeding of babies can also lead
to diarrhea.
Travellers' Diarrhea
 Travelers' diarrhea, is the most common illness affecting travelers. Each year between
20%-50% of international travelers, an estimated 10 million persons, develop diarrhea.
 The onset of Travellers’ Diarrhea usually occurs within the first week of travel but may
occur at any time during travel, and even after returning home.
 The most important determinant of risk is the traveler's destination. High-risk
destinations are the developing countries of Latin America, Africa, the Middle East, and
Asia. Attack rates are similar for men and women. The primary source of infection is
ingestion of fecally contaminated food or water.
 Bacterial enteropathogens cause approximately 80% of Travellers’ Diahrrea. The most
common causative agent isolated in countries surveyed has been enterotoxigenic
Escherichia coli (e.Coli).
 Besides e.Coli and other bacterial pathogens, a variety of viral and parasitic enteric
pathogens also are potential causative agents.
Sign and symptoms

 Most cases of Travelers’ Diarrhea begin abruptly. Typically, a traveler experiences four
to five loose or watery bowel movements each day.
 Other commonly associated symptoms are nausea, vomiting, diarrhea, abdominal
cramping, bloating, fever, urgency, and malaise.
The good news is that Travellers’ Diarrhea is rarely life-threatening. The natural history is
that 90% of cases resolve within 1 week, and 98% resolve within 1 month
Clinical features
A person suffering from diarrhea typically passes abnormally loose stool 4-5 times or more
a day and may show signs of dehydration such as;
 Thirst
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 Dry mucous membranes and lips
 Dry furred tougue
 Sunken eyes
 Lack of tears
 Rapid weight loss
 Rapid and weak pulse
 Inelastic skin
 Less urine (oliguria)
 General weakness
 Sunken fontanelle
Laboratory Diagnosis
A stool sample is taken for ova and cysts and for culture and sensitivity
Types Of Diarrhoea
Most diarrhoea that causes dehydration is loose or watery. Cholera is one example, though
only a small proportion of all loose or watery diarrhoeas are due to cholera.
i. Acute Diarrhoea
Acute Diarrhoea is an episode of diarrhoea that lasts less than 14 days. Acute watery
diarrhoea causes dehydration and contributes to malnutrition. The death of a child with
acute diarrhoea is usually due to dehydration.
ii. Persistent Diarrhoea
Persistent Diarrhoea is an episode that lasts 14 days or more. Up to 20% of episodes of
diarrhoea become persistent, and this often causes nutritional problems and contributes to
death in children.
iii. Dysentery
Dysentery is diarrhoea with blood in the stool, with or without mucus. The most common
cause of dysentery is Shigella bacteria. Amoebic dysentery is not common in young
children. A child may have both watery diarrhoea and dysentery.
Acute Diarrhea
• Increased number of bowel movements
• Loose and watery stools
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•↑ Fluid and electrolyte loss
Types of Acute Diarrhea

•Watery
•Bloody diarrhea (dysentery)
Diarrhea Etiology
• Watery
Rotavirus, Norwalk like viruses, enterotoxigenic E coli (ETEC), Vibrio cholerae,
Staphylococcus aureus, Clostridium difficile, Giardia, and cryptosporidia
•Bloody
Shigella and Entamoeba histolytica. Campylobacter organisms, invasive E coli, Salmonella,
Aeromonasorganisms, C difficile, and Yersinia
Diarrhoea Management
• Maintain appropriate hydration
• Continued feeding
• Drug therapy: limited cases (Integrated Management Childhood Illness)
– Dysentery /cholera
– Antiparasitic (amebiasis/giardiasis)
Persistent Diarrhoea
•>14 days (IMCI > 7 days)
•Causes
•Inadequate diet
•Malabsorption
•Parasitosis
•Management
•Adjust diet
•Consider antiparasitic agents
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Management of Diarrhoea Diseases
Rehydration and electrolytes is the first priority. Give fluids immediately using whatever is
readily available through appropriate route. Appropriate drugs are given after isolating the
causative agent.
a) Oral rehydration solution
In preparing oral rehydration solution (ORS), measure 1 litre of drinking water into a
container and add one sachet of ORS. Taste the solution. It should not be more salty than
tears. Give the patient small sips every few minutes.
Even when the person is vomiting, the vomit is normally less than the solution taken and
some absorption still takes place in the gut. Twenty different campanies make ORS and
have clear instruction of how to make the solution.
 One litre of solution of oral rehydration salts contains 2.9 grams of sodium citrate
dehydrate (best recommended), or 2.9 grams of sodium citrate or 2.5 grams sodium
bicarbonate (also recommended), 1.5 grams of potassium chloride and 20 grams of
glucose (carrier molecule for the solution) or 20 grams sucrose or 40 grams of
common sugar. UNICEF packets are available and contain WHO recommendations.
b) Intravenous Fluid Therapy

Normally, only anout5% of the patients need it, it is administered to those in shock
or in a coma, and to those with uncontrolled vomiting and other complications. Fluid
is given according to age, weight and amount of fluid lost. The type of fluids used
include normal saline, hartman’s solution and dextrose
c) Diet (Food)
A person suffering from diarrhea requires calories and other nutrients. About 6-8 of
the calories given are absorbed. In babies, continue breast-feeding and give orange
juice and other fluids. Feeding should be started with easily digestible foods. Other
foods are normally introduced gradually after 6 hours. These may be fruit juice,
porridge and a light diet. Normal food is given after 12 to 24 hours. When the cause
of diarrhea is identified, say to be cholera, shingella dysentery or amoebiasis, a
specific antibiotic or drug is given. Few cases, however, usually require antibiotics.
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Anti-diarrhoea drugs like mist kaolin and lomotil are not recommended although
some doctors do prescribe them depending on the individual case.
Prevention and Control

Health education on the prevention of diarrhea is a major prevention and control measure
but the main preventive measure is cleanliness, especially when handling, preparing or
serving food as well as when eating, or feeding babies. This means washing hands before
and after handling food and observing strict personal cleanliness. Mothers should be
encouraged to breastfeed their babies during the first four to six months, and if possible, to
continue doing so for a period of at least two years. If this is not possible, bottle feeding
should be discouraged and cow’s milk is given with a cup and spoon. All food should be
fresh and prepared in a clean place using clean water pots and utensils. Doo to be eaten
raw should be thoroughly washed in clean water while uneaten food should be covered to
keep away flies.
Drinking water should be drawn from the cleanest possible source and boiled before
drinking. This water should be stored in a clean container and used only for drinking.
Bathing and washing of clothes and utensils should not be done near the source of drinking
water, nor should stool and urine be passed at or near this source.
People should be taught that dirt, rubbish, stool and urine contain bacteria which cause
infections, including diarrhea. Stool should be passed in a latrine, which should be kept
clean. Stool passed by children near house should be removed and buried if there is no
latrine.
Hand washing should always be washed after visiting the toilet and rubbish should be
burnt, buried or taken far from homestead and away from the source of drinking water
Immunization, especially against measles, also helps in controlling and preventing of
diarrhea. The recommended by WHO on treatment of diarrhea state: if patienthas blood in
stool and diarrhea less than 14 days – treat with appropriate oral antibiotics for shigella
dysentery.
If a child also dehydrated, severely undernourished, less than 1 year of age, reassess the
child’s progress in 24-48 hours. For a severely undernourished child, refer for treatment of
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severe under-nutrition. If patient has diarrohea for longer than 14 days with or without
blood, continue feeding and refer for treatment. If the patient has fever 38.5 o C (101oF) or
greater, show the mother how to cool the child with a wet cloth and fanning and look for
and treat other causes fro instance pneumonia and malaria
2) Bacillary Dysentery (Shigellosis)

Definition
This is an acute bacterial disease of the alimentary tract characterized by diarrhea,
vomiting, fever, abdominal vcramps and tenesmus. An acute bacterial disease involving the
large and distal small intestine, caused by the bacteria of the genus shigella
Infectious agent
It is caused by shigella group of bacilli – which are non-motile and gram-negative. Shigella
is comprised of four species or serotypes.
Group A= Shigella dysentraie (most common cause)
Group B= Shigella flexneri
Group C= Shigella boydii
Group D= Shigella sonnei
Epidemiology
Occurrence- It occurs worldwide, and is endemic in both tropical and temperate climates.
Outbreaks commonly occur under conditions of crowding and where personal hygiene is
poor, such as in jails, institutions for children, day care centers, mental hospitals and
refugee camps. It is estimated that the disease causes 600,000 deaths per year in the world.
Two-thirds of the cases, and most of the deaths, are in children under 10 years of age.
Reservoir-Humans and domestic animals may harbor and disseminate the organisms
Mode of transmission-
Mainly by direct or indirect fecal-oral transmission from a patient or carrier. Transmission
through water and milk may occur as a result of direct fecal contamination. Flies can
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transfer organisms from latrines to a non-refrigerated food item in which organisms can
survive and multiply.
Incubation period-
12 hours-4 days (usually 1-7 days)
Period of communicability
During acute infection and until the infectious agent is no longer present in feces, usually
within four weeks after illness. The carrier state may persist for one to two years
Susceptibility and resistance-

Susceptibility is general. The disease is more severe in young children, the elderly and the
malnourished. Breast-feeding is protective for infants and young children.
Mode of Transmission
The disease may be transmitted through contaminated food, milk, water, hands and the
faecal-oral route. It can also be transmitted indirectly via soiled articles and by flies
Clinical Manifestation/features
The onset is sudden and characterized by
 Fever, rapid pulse, vomiting and abdominal cramp are prominent.
 Anorexia
 Diarrhea usually appears after 48 hours with dysentery supervening two days later.
 Headache
 Malaise
 Generalized abdominal tenderness.
 Tenesmus is present and feces are bloody, mucoid and of small quantity. ( there is
an urge to open the bowel (tetesmus) but it is painful and difficult and if anything
comes out, it is purulent, and contains mucus and blood
 Dehydration is common and dangerous - it may cause muscular cramp, oliguria,
toxemia and shock.
Diagnosis
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 The disease is diagnosed on the based on clinical features
 Stool microscopy (presence of pus cells)
 Stool and rectum swabs of culture and sensitivity
Management
The disease is managed by isolating suspected and confirmed cases until the stool is free
from organism. Rehydration is done orally in mild cases and intravenous fluids given in
severe cases. Strict intake and output charts should be maintained while the patient is put
on bed rest and a light, balanced low residue diet. Concurrently and terminal disinfection
are carried out and the patient’s vital signs, TPR and BP and the general condition i.e pain,
muscle cramps, types of stool, anxiety and signs of dehydration are observed.
The anus which tends to get sores, should be kept dry. The sores can be soothed by
applying petroleum jelly. A daily bath to prevent pressure sores is necessary
Prevention and control

1. Detection of carriers and treatment of the sick will interrupt an epidemic.
2. Handwashing after toilet and before handling or eating food.
3. Proper excreta disposal especially from patients, convalescent and carriers.
4. Adequate and safe water supply.
5. Control of flies.
6. Cleanliness in food handling and preparation.
Diarrhoea Outbreak (e.g Cholera)

•Epidemiologic surveillance
•SUSPECT! (adults with dehydration )
•Early identification of suspected cases
•Culture confirmation
•Report
•Active investigation and treatment of secondary cases
•Strengthen preventive measures
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DIARRHEA
0-2 months old infants
Severe disease if:

•Newborn (diferenciate from transition stools)
•Persistent ( > 7 days)
•Bloody
–Infection
–Necrotizing enterocolitis
–Sepsis
–Hemorrhagic disease of the newborn
–Cow’s milk allergy
Dehydration
Negative Water Balance (With Or Without Electrolytic And Acid-Base Disturbances)
Dehydration Evaluation
 Assess Degree
 Identify Type
WEIGHT LOSS (%)
0-5 Years > 5 years
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MILD Up to 5% 3%
MODERATE >5 - 10% 6%
SEVERE > 10% 9%
3) Cholera
Pathogen: Vibrio cholera.
Modes of Transmission: Faecal Oral Route. Robert Koch (1843-1910) discovered cholera.
John Snow (1913) was the first to demonstrate that cholera is transmitted by contaminated
water.
Incubation period: It varies from a few hours to 2-3 days.
Signs and Symptoms:
The patient starts passing stools frequently, which are white like rice water, and gets
repeated vomiting. The disease can be diagnosed by the microscopic examination of the
stool or the vomit when the typical comma-shaped cholera vibrio’s can be seen.
Treatment:
Rapid replacement of fluid and electrolytes is needed by oral rehydration- therapy. You can
make your own oral rehydration solution (ORS) at home by adding one teaspoon of sugar
and a pinch of salt to one quarter of water. Drugs tetracycline and chloramphenicol are
used.
4) Poliomyelitis or Polio (Infantile Paralysis)
Pathogen: Enter virus (Poliovirus)
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Modes of Transmission: Polio virus usually enters the body via alimentary canal (faecal
oral route) where it multiplies and reaches the nervous system through the blood stream.
Incubation Period: 7 to 14 days
Signs and Symptoms:
It produces inflammation of the nervous system. Stiffness of the neck is an important sign.
Paralysis starts following the weakness of particular skeletal muscles. The attack of
paralysis begins with high fever, headache, chilliness, pain all over the body.
Prevention and Treatment:
There must be provided an adequate arrangement for proper disposal of urine and faeces
of the patient, because they contain polio virus. Overcrowding of children in schools,
playgrounds and cinema halls should be avoided. Polio is preventive. Polio vaccine is safe
and effective. The first polio vaccine was prepared by Jonas Salk (1953). The killed virus is
called “Salk Vaccine” and injected to develop immunity. Jonas Salk is called “father of polio
vaccine”.
Sabin et al prepared an oral vaccine known as OPV (Oral Polio Vaccine).
B. Airborne Diseases
1) The Common Cold

The term “common cold” refers to a mild upper respiratory viral illness. It is self-limited
therefore it will go away without treatment. It is the most frequent acute illness in the
United States. It is separate and a distinctly different illness than influenza, throat infection,
bronchitis, sinusitis, pertussis, and allergic rhinitis.
The average person has two or three colds a year. Colds are caused by many viruses, which
cause similar symptoms. The same virus can cause another cold after re-exposure.
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However, the second illness is usually milder and lasts for a shorter period of time.
Seasonal patterns may be seen for some of the viruses.
Transmission:
Common cold viruses can be spread by three mechanisms:
O Direct contact –colds are primarily spread from person-to-person via hands.
The virus can stay alive on the skin for at least two hours. Thus, if a sick person
shakes someone’s hand and that individual then touches his eye, nose, or mouth, the
virus can be transmitted and later infect that person.
O Indirect contact –viruses may survive on surfaces such as countertops for several
hours thus can be transmitted from touching that surface and then touching the
mouth, nose, or eyes.
O Inhaling viral particles –droplets containing viral particles can be breathed,
coughed, or sneezed into the air and transmitted to others if another person is
standing close (within a few feet) and the droplet touches that person’s eye, nose, or
mouth. Covering the mouth while coughing or sneezing reduces this risk.
 Persons with colds shed viruses the most on the second day of illness, however, low levels
of viral shedding may persist for up to two weeks.
 Saliva generally does not spread the common cold virus as most people with a cold have
no detectable virus in their saliva.
Studies of using recirculated air in commercial airliners versus fresh air ventilation show
no difference in the number of colds reported by persons after the flight.
Risk factors:
There are some factors that can increase the risk and severity of illness with a cold. There is
no scientific basis for the belief that a cold climate increases susceptibility to getting a
respiratory illness. Increased risks of developing cold symptoms occur with:
1. Psychological stress
2. Lack of sleep or sleep disturbances
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3. Exposure to children in daycare settings
Increased severity of colds is often seen with:

 Underlying chronic diseases
 Immunodeficiency disorders
 Malnutrition
 Cigarette smoking
Clinical features:
Symptoms of the common cold are mostly due to the response of the individual to the
infection, rather than to direct damage to the respiratory tract from the virus. Symptoms
vary from person to person and include:
 Rhinitis (runny nose) and congestion are the most common symptoms.
 Sore throat, sneezing, cough, malaise (feeling ill)
 Fever is uncommon in adults but may be present in children
 Purulent (colored, thick drainage containing pus) drainage may be seen with the
common cold. The presence of purulence does not distinguish between a cold or
sinus infection.
Incubation period/symptom duration:

 From the time of contact until onset of symptoms is generally 24 to 72 hours but can be as
early as 10 to 12 hours after exposure.
 Symptoms usually last 3 to 10 days, but can last up to two weeks in some people.
Diagnosis:
The diagnosis is based on symptoms and observed signs.
 Swelling and congestion of nasal passages
 Redness of the throat
 Enlarged lymph nodes in the neck
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 Normal lung exam
Chest x-rays not needed unless chest exam is abnormal
Conditions that can mimic a cold include:

 Allergic or seasonal rhinitis –a cough or sore throat are usually not seen with allergies.
 Bacterial throat infection or tonsillitis –nasal congestion and drainage are not generally
seen with a bacterial throat infection or tonsillitis.
 Bacterial sinus infections –usually associated with significant facial pain and purulent
nasal discharge.
 Influenza –usually associated with high fever, headache, and body aches.
During flu season, obtain nasal swabs for rapid flu testing
 Pertussis –associated with prolonged coughing, sometimes associated with vomiting.
Complications:
 Acute sinus infections are a rare complication in adults with colds. Viral sinusitis occurs
more frequently than secondary bacterial sinusitis. Viral sinusitis will resolve within 3
weeks without antibiotic treatment.
 Lower respiratory tract disease:
O RSV (respiratory syncytial virus) can cause an infection in the lungs especially in
children, older adults, and immune compromised patients.
O Acute asthma attacks occur with colds thought to be due to changes in airway
reactivity which can last up to four weeks following an infection.
 Ear infections:
O Because colds cause problems with drainage and pressure regulation of the
middle ear, an acute ear infection (otitis media) can occur.
Treatment:
Symptomatic therapy is the only thing necessary for treating the common cold as it is a
self-limited infection (meaning it will go away with time). Antibiotics are not effective and
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should not be prescribed unless there is convincing evidence of the presence of a bacterial
infection.
Some medications used to treat symptoms include:

 Cromolyn sodium (NasalCrom®) –may relieve runny nose, cough, and sneezing.
 Antihistamines
O Antihistamines such as diphenhydramine (Benadryl®) may alleviate sneezing and
a runny nose but their use is limited by side effects of drowsiness or sedation, as
well as dry eyes, nose and mouth. Non-sedating antihistamines such as Claritin® are
not effective.
 Antitussives (cough medicines)
O Cough associated with the common cold is usually caused by nasal obstruction
and postnasal drip. Cough suppression is usually not needed though studies show
that dextromethorphan is more effective than codeine.
 Expectorants
O Guaifenesin (Mucinex®) will thin secretionsand may be of some benefit in
decreasing cough.
 Decongestants
oTopical or oral decongestants such as pseudoephedrine or phenylephrine may
temporarily relieve nasal congestion.
oTopical decongestants should be limited to two to three days because a rebound
syndrome will occur after 72 hours of use meaning that the symptoms of congestion
and drainage that the decongestant was treating will return and possibly worsen.
They can also cause nosebleeds, agitation, insomnia, and worsen hypertension.
O Purchase of pseudoephedrine-containing cold medications is limited due to use in
manufacture of amphetamine drugs. These can decrease congestion but have the
same side effects as topical decongestants.
O Phenylephrine is a common component of over-the-counter cold preparations but
is not very effective.
 Intranasal glucocorticoids
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O Topical glucocorticoids such as Flonase®, Nasonex®, etc. are of no proven benefit
for patients with the common cold though are of benefit in treating patients with
allergic rhinitis.
 Zinc
O Zinc intake has been shown to be associated with a reduction in the duration and
severity of cold symptoms.
O However, zinc containing products, especially intranasal ones, have been
associated with the permanent loss of smell.
 Vitamins and herbal remedies
O Vitamin C –if started after the onset of cold symptoms does not reduce symptom
severity or duration.
O Echinacea –studies have failed to demonstrate any benefit when used to treat the
common cold.
 Antiviral therapy
O There are studies using intranasal interferon for the treatment of the common
cold. There may be some benefit to the use of interferon but the safety and
practicality of use has yet to be determined and this product is not currently
available.
 Antibiotic therapy
O Treatment with antibiotics for the common cold causes more harm than benefit.
Antibiotics do not kill viruses and should not be prescribed for a cold. Adults treated
with antibiotics have a risk for developing allergic reactions such as rashes; GI
symptoms such as diarrhea, nausea, vomiting; swelling of the face; seizures;
dizziness; etc.
 Analgesics
O Acetaminophen and non steroidal anti-inflammatory drugs (NSAIDs) reduce
headaches, achiness, and fevers. They do not improve cough or nasal discharge and
do not reduce the duration of symptoms.
Prevention:
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 Studies have not proven that the use of alcohol gels prevent developing symptoms of a
respiratory illness as the virus can be spread by inhaling droplet particles. However
general hygienic measures such as hand washing have been shown to prevent the spread of
respiratory viruses especially from younger children.
 Decontamination of environmental surfaces with disinfectants that kill viruses may help
decrease the rate of transmission. However a study of the effectiveness of antibacterial
cleaning products failed to show a difference when compared to standard cleaning
products in the incidence of colds.
 Vitamins -regular supplementation with vitamins C, D, and E have not been shown to
decrease the incidence of colds.
 Zinc –there have been studies that show that children taking zinc sulfate decreased the
rate of development of colds, however studies have not shown this to work for adults. Zinc,
especially when found in intranasal products, can lead to the loss of smell.
2) Tuberculosis (ТВ) or Koch’s Disease:
Pathogen:
Mycobacterium tuberculosis.
Modes of Transmission:
The bacteria damage the tissues and release a toxin named tuberculin which produces the
disease. It affects the lungs, lymph nodes, bones and joints.
Modes of infection includes infection by inhalation of droplets expelled by tubercular

patients, infection of food and drink contaminated with bacteria of tuberculosis, milk from
a tubercular cow, etc.
Incubation period:
3-6 weeks (variable).
Signs and Symptoms:
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Symptoms of pulmonary (lungs) tuberculosis are fever, cough, blood containing sputum,
pain in the chest and loss of weight, excessive fatigue, failure of appetite, slight rise of
temperature in the evening, hoarseness of throat, night sweating and rapid pulse. Diagnosis
of ТВ is done by Mantoux Test.
BCG vaccine gives protection against tuberculosis. When coughing, he/she should keep the
handkerchief before his/her mouth. Tuberculosis is curable.
Isoniazid, Streptomycin and Rifampicin drugs are used to treat Tuberculosis.
3) Pneumonia
Pathogen: Streptococcus pneumoniae and Haemophilus influenzae. Pneumonia is a serious

disease of the lungs.
Modes of Transmission: The disease spreads by sputum of the patient.
Incubation period: 1-3 days.
Signs and Symptoms:
Lymph and mucus collect in the alveoli and bronchioles of the lungs so that the lungs do not
get sufficient air. Therefore, proper exchange of gases does not take place in the alveoli. No
vaccine is available
Treatment:
Use of Penicillin, Streptomycin and Ampicillin.
4) Measles
History of Measles
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Measles is an acute viral infectious disease. References to measles can be found from as
early as the 7th century. The disease was described by the Persian physician Rhazes in the
10th century as “more to be dreaded than smallpox.”
In 1846, Peter Panum described the incubation period of measles and lifelong immunity
after recovery from the disease. Enders and Peebles isolated the virus in human and
monkey kidney tissue culture in 1954. The first live attenuated vaccine was licensed for use
in the United States in 1963 (Edmonston B strain).
Before a vaccine was available, infection with measles virus was nearly universal during
childhood, and more than 90% of persons were immune by age 15 years. Measles is still a
common and often fatal disease in developing countries. The World Health Organization
estimates there were 145,700 deaths globally from measles in 2013.
Measles infection was distinguished from smallpox as early as the 9th century by an Arab
physician by the nameof AbuBecr Razi (the Doctor of Baghdad).
• However, there is no record of repeated epidemics identified as measles until the 11th
and 12th centuries.
• Measles was first mentioned as a childhood disease in 1224.
• The Danish physician Peter Panum is generally given credit for illuminating the basic
principles of measles infection and epidemiology during his trip to the Faroe Islands in
1846 during a measles epidemic.
• Estimated to have killed about 200 million worldwide in the last 150 years
Family Paramyxoviridae, Genus Morbilivirus

• It is 100-200 nm in diameter, with a core of single-stranded RNA, and is closely related to
the rinderpest and canine distemper viruses.
• Two membrane envelope proteins are important in pathogenesis. They are the F (fusion)
protein, which is responsible for fusion of virus and host cell membranes, viral penetration,
and hemolysis, and the H (hemagglutinin) protein, which is responsible for adsorption of
virus to cells.
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• There is only one antigenic type of measles virus. Although studies have documented
changes in the Hglycoprotein, these changes do not appear to beepidemiologically
important (i.e., no change in vaccine efficacy has been observed).
• Measles virus is rapidly inactivated by heat, light, acidic pH, ether, and trypsin. It has a
short survival time (<2 hours) in the air, or on objects and surfaces.
Progress in Measles Control --- Kenya 2002--2007
In 2000, countries represented by the World Health Organization (WHO) Regional Office
for Africa established a goal to reduce, by the end of 2005, measles mortality to 50% of the
506,000 deaths from measles estimated in 1999.
Strategies adopted included strengthening routine vaccination, providing a second

opportunity for measles vaccination through supplemental immunization activities (SIAs),
monitoring disease trends, and improving measles case management.
In Kenya, an east African country with a population estimated at 33.4 million in 2005, the
Kenya Expanded Programme on Immunization (KEPI) in the Ministry of Health began
implementing these strategies in 2002 with a wide age range catch-up SIA* and reduced
the number of reported measles cases by >99%, from 11,304 in 2001 to 20 in 2004. A
follow-up SIA, initially scheduled for July 2005, was postponed to 2006 to include
concurrent distribution of long-lasting insecticide-treated bed nets (LLINs).
This report documents progress made in reducing measles morbidity and mortality in
Kenya and describes the consequences of a large measles outbreak, beginning in
September 2005, on the integrated measles follow-up SIA
Immunization Activities
KEPI was established within the Kenya Ministry of Health in 1980, with the goal of
immunizing all children in the country against six vaccine-preventable diseases. § National
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coverage with 1 dose of measles vaccine (provided at age 9 months) increased in the early
1990s to 84% of children aged 12 months but decreased to 72% in 2002.
To accelerate measles control, goals were established in 2002 to achieve and maintain
national average measles vaccination coverage at 90%, with every district expected to
attain a coverage of >85%. Since then, reported national measles vaccination coverage
increased to 77% in 2006, and the proportion of districts with coverage >85% increased
from 10% in 2002 (eight of 77 districts) to 35% in 2006 (27 of 78 districts).
To provide a second opportunity for measles vaccination, a nationwide measles catch-up

SIA was conducted in June 2002, targeting children aged 9 months--14 years;
approximately 13 million children were vaccinated, 98% of the estimated target
population. A multistage cluster survey provided a similar estimate of national measles SIA
coverage at 94%, with seven of nine provinces achieving coverage >90%. The two
exceptions were North East Province at 84% and Coast Province at 90%
Measles Surveillance
After the 2002 measles catch-up SIA, Kenya implemented a system of case-based
surveillance for measles within the existing surveillance network for acute flaccid paralysis.
In this system, for each suspected measles patient who visits a health facility, a measles
case report form is completed, and a blood specimen is taken for measles immunoglobulin
M testing at the national measles laboratory.
In an outbreak, defined as five or more cases reported from the same health area in a
month, specimens are collected from five cases. If three or more test positive, the outbreak
is confirmed as measles, untested cases are confirmed by epidemiologic linkage, and
specimen collection stops after throat swabs are collected for viral genotyping.
In 2003, a total of 1,791 suspected measles cases were reported through this case-based
surveillance system, including 59 cases that were confirmed by laboratory or
epidemiologic linkage. In 2004, a total of 1,968 suspected cases were reported, including 20
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that were confirmed; in 2005, a total of 1,061 suspected cases were reported, including 151
that were confirmed.
During 2003--2005, more than 99% of suspected cases were reported with a blood
specimen, and the proportion of districts reporting at least one suspected measles case
increased from 69% in 2004 to 99% in 2005.
Measles Virus
The measles virus is a paramyxovirus, genus Morbillivirus.
It is 120–250 nm in diameter, with a core of single-stranded RNA, and is closely related to
the rinderpest and canine distemper viruses. Two membrane envelope proteins are
important in pathogenesis.
They are the F (fusion) protein, which is responsible for fusion of virus and host cell
membranes, viral penetration, and hemolysis, and the H (hemagglutinin) protein, which is
responsible for adsorption of virus to cells.
There is only one antigenic type of measles virus. Although studies have documented
changes in the H glycoprotein, these changes do not appear to be epidemiologically
important (i.e., no change in vaccine efficacy has been observed).
Measles virus is rapidly inactivated by heat, sunlight, acidic pH, ether, and trypsin. It has a
short survival time (less than 2 hours) in the air or on objects and surfaces
Pathogenesis
Measles is a systemic infection. The primary site of infection is the respiratory epithelium
of the nasopharynx. Two to three days after invasion and replication in the respiratory
epithelium and regional lymph nodes, a primary viremia occurs with subsequent infection
of the reticuloendothelial system.
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Following further viral replication in regional and distal reticuloendothelial sites, a second
viremia occurs 5–7 days after initial infection. During this viremia, there may be infection
of the respiratory tract and other organs. Measles virus is shed from the nasopharynx
beginning with the prodrome until 3–4 days after rash onset.
Clinical Features
The incubation period of measles, from exposure to prodrome, averages 10–12 days. From
exposure to rash onset averages 14 days (range, 7–21 days).
The prodrome lasts 2–4 days (range 1–7 days).
It is characterized by fever, which increases in stepwise fashion, often peaking as high as

103°F –105°F. This is followed by the onset of cough, coryza (runny nose), or conjunctivitis.
Koplik spots, a rash present on mucous membranes, is considered to be pathognomonic for
measles.
It occurs 1–2 days before the rash to 1–2 days after the rash, and appears as punctate blue-
white spots on the bright red background of the buccal mucosa.
The measles rash is a maculopapular eruption that usually lasts 5–6 days. It begins at the
hairline, then involves the face and upper neck. During the next 3 days, the rash gradually
proceeds downward and outward, reaching the hands and feet.
The maculopapular lesions are generally discrete, but may become confluent, particularly
on the upper body. Initially, lesions blanch with fingertip pressure. By 3–4 days, most do
not blanch with pressure. Fine desquamation occurs over more severely involved areas.
The rash fades in the same order that it appears, from head to extremities.
Other symptoms of measles include anorexia; diarrhea, especially in infants; and
generalized lymphadenopathy.
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Measle Systoms
• Disease caused by the measles virus is typically marked by a prodrome of fever,
conjunctivitis, coryza, and cough which is followed by the development of a rash of flat
macules which first appear on the head and then move to the chest, trunk, and limbs. These
macules typically fuse resulting in large blotches that can be slow to fade.
• Children get complications like diarrhea
• According to the WHO, the yearly global incidence of measles is estimated to be 50 million
cases, of which 1.5 million are fatal.
– Healthy populations 1 death per thousand cases
– Developing nations around 10% mortality
– In immunocompromised people upto 30% mortality
• Two serious complications of measles infection are acute postinfectious encephalitis,
which occurs in about 1 in every 1,00
0 cases (15% mortality), and subacute sclerosing panencephalitis (SSPE), which occurs in
about 1 in every 300,000 cases (fatal).
Measles Treatment
There is no standard antiviral treatment for measles although ribavirin (1 fl-D-

ribofuranosyl-1, 2, 4-triazole- 3-carboxamide) has been shown to decrease viral replication
in vivo and might decrease the severity of acute measles.
• Vitamin A supplements have been shown to decrease both the morbidity and mortality of
acute measles, even if the individual is not suffering from a vitamin A deficiency.
• Finally, numerous agents have been suggested for therapeutic treatment of SSPE but it is
extremely difficult to determine their efficacy because
Complications
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Approximately 30% of reported measles cases have one or more complications.
Complications of measles are most common among children younger than 5 years of age
and adults 20 years of age and older.
From 1985 through 1992, diarrhea was reported in 8% of measles cases, making this the
most commonly reported complication of measles. Otitis media was reported in 7% of
cases and occurs almost exclusively in children. Pneumonia (in 6% of reported cases) may
be viral or superimposed bacterial, and is the most common cause of measles-related
death.
Acute encephalitis occurs in approximately 0.1% of reported cases. Onset generally occurs
6 days after rash onset (range 1–15 days) and is characterized by fever, headache,
vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma. Cerebrospinal
fluid shows pleocytosis and elevated protein.
The case-fatality rate is approximately 15%. Some form of residual neurologic damage
occurs in as many as 25% of cases. Seizures (with or without fever) are reported in 0.6%–
0.7% of cases.
Death from measles was reported in approximately 0.2% of the cases in the United States
from 1985 through 1992. As with other complications of measles, the risk of death is
highest among young children and adults. Pneumonia accounts for about 60% of deaths.
The most common causes of death are pneumonia in children and acute encephalitis in
adults.
C. Zoonotic Diseases
1) Rabies (Hydrophobia):
Pathogen:
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Rabies virus.
Symptoms and Modes of Transmission:
The virus is introduced in the body by the bite of rabid (mad) dogs usually. It can be
injected by the bite of jackals, wolves, cats etc.,
Incubation period:
10 days to one year.
Signs and Symptoms:
Fear of water is the most important characteristic symptom of this disease. Other
symptoms are saliva from the mouth, severe headache, high fever, alternating periods of
excitement and depression, inability to swallow even fluids due to choked throat. The virus
destroys the brain and spinal cord. Rabies is 100% fatal.
There should be compulsory immunisation of dogs and cat population. All ownerless and
stray dogs should be destroyed. Wound of the bitten person should be immediately washed
with soap and water. After this give anti rabies vaccine to the patient. The pet should be
watched for 10 days after it has bitten someone to make sure that it does not have rabies
virus.
D. Vector Borne Diseases
1) Malaria
Pathogen: Malarial parasite (= Plasmodium). Plasmodium has two hosts:
(a) Female Anopheles Mosquito:
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As the sexual phase of the malarial parasite occurs in the mosquito it is considered the
definitive (= primary) host of malarial parasite.
(b) Human beings:
As the asexual phase of the malarial parasite occurs in man, it is considered the
intermediate (= secondary) host. As the female Anopheles mosquitoes feed on blood, only
they can serve as vector hosts (= carrier) of malarial parasites. The parasite does not harm
the mosquito.
Historical Aspects:
Lancisi (1717) first suspected a relationship between swamp, malaria and mosquito.
Laveran (1880) discovered that malaria is caused by protozoan parasite. In fact he
discovered Plasmodium. He got Nobel Prize in 1907. His topic of discovery was “Role of
Protozoans in Causing Disease”.
Golgi (1885) confirmed Laveran’s discovery by observing stages of Plasmodium malariae in

human RBCs. In 1897 Sir Ronald Ross, a doctor who was born at Almora in India and he
was in Indian Army, established that malarial parasite is transmitted by the bite of a female
Anopheles mosquito. In 1902, he got Nobel Prize for this discovery. He worked in India.
Life Cycle of Plasmodium:
Life cycle of Plasmodium requires two hosts for completion, such a two host life cycle is
called digenetic.
I. Life Cycle of Plasmodium in Man:
1. Infective stage of Plasmodium is sporozoite. When the mosquito bites another human,
sporozoites are injected with bite.
2. Parasites (sporozoites) reach the liver through blood.
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3. The parasite reproduces asexually in liver cells, bursting the cell and releasing into the
blood.
4. Parasites enter the red blood cells and reproduce asexually there bursting the red blood
cells and causing cycles of fever and other symptoms. Released parasites infect new red
blood cells.
5. Sexual stages (gametocytes) develop in red blood cells.
II. Life Cycle of Plasmodium in Female Anopheles mosquito:
 Female mosquito takes up gametocytes with blood meal.

 Fertilisation and development take place in the mosquito’s stomach.
 The zygote elongates and becomes motile called ookinete.
 The ookinete moves and bores through the wall of the stomach of female Anopheles
mosquito. The ookinete changes to oocyst on the surface of the stomach.
 Inside the oocyst, sporozoites are formed which are released in the body cavity of the
mosquito.
 Mature infective stages (sporozoites) move to different organs of the body cavity but
many of them penetrate salivary glands of the mosquito.
 When the female Anopheles mosquito bites a healthy person, the sporozoites are
injected in his/her blood along with saliva.
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Human Species of Plasmodium and Types of Malaria:
In human beings, malaria is caused by four species.
1. Plasmodium vivax:
It is most common in India. It is less common in Africa. Its incubation period is about 14
days. It causes Benign Tertian Malaria. Recurrence of fever is after every 48 hours (every
third day). Recurrent attacks of fever are called paroxysms.
2. Plasmodium falciparum:
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It is common in certain parts of India. It is the greatest killer of human beings over most
parts of Africa and else where in tropics. Its incubation period is about 12 days. Recurrence
of fever is after every 48 hours (every third day). It causes Malignant (=Aestivo-autumnal
or Pernicious or Cerebral or Tropical) Tertian Malaria.
3. Plasmodium malariae:
It is common in tropical Africa, Burma, Sri Lanka and parts of India. It is less common in
India. This was the species of malarial parasite discovered by Laveran. This is the only
species which can also infect other primates. Its incubation period is 28 days. Recurrence of
fever is after 72 hours (every 4th day). It causes Quartan Malaria.
4. Plasmodium ovale:
This is the rarest of the four species which infect man. It is mostly found in tropical Africa.
It is usually not seen in India. Its incubation period is about 14 days. It causes Mild Tertian
Malaria.
Pigment granules (dots) in the cytoplasm of infected RBCs in four Species of

Plasmodium:
P. vivax P. falciparum P. malariae P. ovale

Schuffner’s dots Maurer’s dots Ziemann’s Jame’s dots
dots
Symptoms of Malaria:
The patient displays symptoms of malaria fever after a period of 14 days from infectious
bite. Early restlessness, less appetite and slight sleeplessness are followed by muscular
pains, headache and a feeling of chilliness. In response to chills the body temperature starts
rising and may reach 106°F at the height of fever. The patient sweats a lot and the
temperature steadily goes down to normal, till the next attack takes place after 48 hours.
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Control of Malaria:
Malaria is widely spread disease in India. There is separate antimalaria department of the
government which controls malaria through National Malaria Eradication Programme
(NMEP).
(a) Treatment of the patient:
Quinine, the oldest drug for malaria, and other drugs are also used for this purpose.
Quinine is extracted from the bark of the cinchona tree which is mostly growing in West
Indies, India, Sri Lanka, Java and Peru. Other anti-malarial drugs are paludrine and
Primaquin, Chloroquinine, Camoquin and Comoprima. Now malaria is also being treated
with sulpha drugs such as sulphadoxin, dapsone, etc.
(b) Prevention of Infection:
Ducks, larvivorous fish like Gambusia, some adult insects like dragon flies, insectivorous
plants such as Utricularia, are the natural enemies of mosquito larvae and pupae as they
feed upon them. These may be introduced in the water containing the larvae and pupae.
2) Chikungunya:
Pathogen:
It is caused by Chikungunya virus. This virus was first isolated from human patients and
Aedes aegypti mosquitoes from Tanzania in 1952. The name ‘Chikungunya’ is derived from
the native word for the disease in which patient lies “doubled up” due to severe joint pains.
Epidemics of chikungunya have occurred in many African countries.
Mode of Transmission:
By the bite of Aedes aegypti mosquito. No vaccine is available.
Signs and Symptoms:
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Its symptoms include sudden onset of fever, crippling joint pains, lymphadenopathy and
conjunctivitis. Some show haemorrhagic manifestations. The fever is typically biphasic.
Chikungunya has been reported from India.
Incubation Period:
Usually 3-6 days
Preventive measures include elimination of mosquitoes and their eggs. Paracetamol is

given to reduce fever, analgesic (drug that relieves pain) drugs such as aspirin for the joint
pain. Bed rest and adequate fluid intake are also recommended.
3) Dengue Fever (Break-bone fever):
Pathogen:Dengue fever is caused by mosquito borne flavi-ribo virus.
Mode of Transmission: The virus of dengue fever is transmitted by the bite of Aedes
aegypti (mosquito).
Incubation Period: 3 to 8 days
Types of Dengue Fever:
Two types of dengue fever are common: classical dengue fever and dengue haemorrhagic.
(a) Symptoms of Classical Dengue Fever:
(i) Abrupt onset of high fever,
(ii) Severe frontal headache,
(iii) Pain behind the eyes which worsens with eye movement,
(iv) Muscles and joint pains,
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(v) Loss of sense of taste and appetite,
(vi) Measles like rash over chest and upper limbs,
(v) Nausea and vomiting.
(b) Symptoms of Dengue Haemorrhagic Fever:
Symptoms similar to classical dengue fever except the following:
(i) Bleeding from the nose, mouth, gums and skin bruising,
(ii) Severe and continuous stomach pains,
(iii) Frequent vomiting with or without blood,
(iv) Pale cold or clammy skin,
(v) Excessive thirst (dry mouth),
(vi) Rapid weak pulse,
(vii) Difficulty in breathing,
(viii) Restlessness and constant crying.
No vaccine for Dengue fever is available.
Mosquitoes and their eggs should be eliminated.
No specific therapy is available. Symptomatic care including bed rest, adequate fluid intake
and analgesic medicine is recommended. Do not take aspirin and dispirin.
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NON COMMUNICABLE DISEASES
1) Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic autoimmune disease. It causes joints to swell and
can result in pain, stiffness, and progressive loss of function. In addition to joint pain and
stiffness, people with RA may also have symptoms such as weight loss, low-grade fever, and
fatigue.
RA often affects pairs of joints (both hands, both feet, etc) and can affect more than one
joint, including the small joints in the wrists and hands. Over time, other joints can be
affected such as shoulders, elbows, knees, feet, and ankles.
Over time, the inflammation of RA can cause damage to the joints. In some patients, this
may lead to permanent joint damage. As this joint damage progresses, in severe cases, it
can cause deformity of the joints and loss of function. It may begin to interfere with daily
activities, making them more difficult and painful to do.For these reasons, it’s important to
get an accurate diagnosis as early as possible.
About 1.3 million Americans suffer from RA. It affects people worldwide at a similar rate.
RA often begins in middle age, but can start at any age. RA affects 2 to 3 times as many
women than men.
Causes of RA
The exact cause of RA is not known. Research has found that there are many possible
causes, including:
 Genetics. People with family members who have RA may be more likely to get it
 Hormones. Female hormones may play a role in the disease
 Viruses or bacteria. RA may be related to viruses or bacteria that you come in

contact with during your life
Effects on the body
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Some of the most common symptoms a person with RA may experience are stiffness in the
morning and pain and swelling of joints—often in the same joint on both sides of the body.
As RA progresses, joint damage may worsen. This can also cause the surrounding muscles,
ligaments, and tendons to become weak and unable to work normally.
Symptoms of the disease may appear, go away for some time, and then return, making
diagnosis even more difficult. But remember, RA is a disease that progresses over time.
That is why it is so important to get an accurate diagnosis as early as possible.
Up to 40% of people with RA may develop other conditions during the course of their
disease. While RA affects the joints, people with RA may also be more likely to have the
following conditions:
 Heart disease
 Rheumatoid nodules (knots of tissue under the skin)
 Bone loss
 Sjö gren’s syndrome (dry mouth and dry eyes) and other eye problems
 Anemia
 Infections
 Lung disease
Some of these conditions may be a result of having RA. Medications used to treat RA could
increase some of these risks as well.
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Signs and Symptoms of RA
RA affects different people in different ways. Symptoms may slowly develop over several
years, or the disease may progress quickly. Symptoms may be mild or very severe. You may
go through phases called “flares” or “flare-ups” when symptoms are severe. At other times,
it may seem as if the disease and its symptoms have gone away. This is called “remission.”
Joint pain and swelling may happen slowly and may occur over weeks or months. The small
joints in the wrists and hands are often inflamed first. Over time, other joints may be
painful and swollen due to RA. The common signs and symptoms of RA include:
 Painful joints
 Swollen joints
 Stiffness in joints, particularly in the morning
 Low fever
 Fatigue
 Loss of appetite
 Feeling weak
 Lumps under the skin, especially on the hands or elbows
 Weight loss
 Over time, decreased range of motion
 Dry eyes and mouth
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Diagnosing and Managing RA
There is no one test that can show that you have RA. But your doctor can use a combination
of tools to help diagnose RA:
Medical and family history
Do you have a relative with RA?
What medications have you been taking?
Do you have any other medical conditions?
Physical exam
Reflexes, muscle strength, and general health
Ability to walk, bend, and carry out activities of daily living
Evidence of inflammation in the lungs
Symptoms
Pain, stiffness, and trouble with range of motion
Lab tests
Rheumatoid factor (RF)
Anti-cyclic citrullinated peptide (anti-CCP) antibody test
Other tests include white blood-cell count, anemia test, erythrocyte sedimentation rate
(ESR), and C-reactive protein
X-rays
To determine the degree of joint damage
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It is important to get an accurate diagnosis and appropriate treatment as early as possible.
Even though symptoms may not appear like RA (for example, fatigue, weakness, low-grade
fever, and weight loss), you should discuss all symptoms with your doctor.Early diagnosis
of RA is the first step to managing your disease and symptoms.
Treatment of RA
Once one has diagnosed with RA, it is very important to start treatment as soon as possible.
The goals of treatment are to:
i. Reduce pain
ii. Decrease or stop further joint damage
iii. Improve physical function
The details of your treatment plan will depend on the progress of the disease. Your
rheumatologist can suggest various treatment options, such as lifestyle changes,
medications, and sometimes surgery.
Lifestyle changes that can help in the management of RA include:
 Rest and exercise
 Joint care
Medications that can help decrease pain and/or swelling include:
 Pain relievers
 Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Corticosteroids
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Medications that can help reduce inflammation, and may also slow the rate of joint
damage include:
 Non-biologic disease-modifying antirheumatic drugs (DMARDs)
 Biologic DMARDs for patients with moderate-to-severe RA
All medications have side effects. It is important to discuss the risks and benefits of your
treatment options with your doctor in order to find the proper treatment plan for you.
 Stress reduction
 Healthy diet
 Seeing a rheumatologist
2) Osteoarthritis
Osteoarthritis is a joint disease that mostly affects cartilage. Cartilage is theslippery tissue
that covers the ends of bones in a joint. Healthy cartilage allowsbones to glide over each
other. It also helps absorb the shock of movement. Inosteoarthritis, the top layer of
cartilage breaks down and wears away. This allowsbones under the cartilage to rub
together. The rubbing causes pain, swelling, andloss of motion of the joint. Over time, the
joint may lose its normal shape. Also,
bone spurs may grow on the edges of the joint. Bits of bone or cartilage can breakoff and
float inside the joint space, which causes more pain and damage.People with osteoarthritis
often have joint pain and reduced motion. Unlike someother forms of arthritis,
osteoarthritis affects only joints and not internal organs.Osteoarthritis occurs most often in
older people. Younger people sometimes getosteoarthritis, primarily from joint injuries.
Causesof Osteoarthritis
Osteoarthritis usually happens gradually over time. Some risk factors that might
lead to it include:
 Being overweight.
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 Getting older.
 Joint injury.
 Joints that are not properly formed.
 A genetic defect in joint cartilage.
 Stresses on the joints from certain jobs and playing sports.
Diagnosis
Osteoarthritis can occur in any joint. It occurs most often in the hands, knees, hips,
and spine. Warning signs of osteoarthritis are:
 Stiffness in a joint after getting out of bed or sitting for a long time.
 Swelling or tenderness in one or more joints.
 A crunching feeling or the sound of bone rubbing on bone.
2
No single test can diagnose osteoarthritis. Most doctors use several methods to diagnose
the
disease and rule out other problems:
 Medical history.
 Physical exam.
 X rays.
 Other tests such as blood tests or exams of the fluid in the joints.
Doctors often combine treatments to fit a patient's needs, lifestyle, and health.
Osteoarthritis
treatment has four main goals:
 Improve joint function.
 Keep a healthy body weight.
 Control pain.
 Achieve a healthy lifestyle.
Osteoarthritis treatment plans can involve:
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 Exercise.
 Weight control.
 Rest and joint care.
 Nondrug pain relief techniques to control pain.
 Medicines.
 Complementary and alternative therapies.
 Surgery.
3) Cancer
Facts
 Cancer is the uncontrolled growth of abnormal cells anywhere in a body.

 There are over 200 types of cancer.
 Anything that may cause a normal body cell to develop abnormally potentially can
cause cancer; general categories of cancer-related or causative agents are as follows:
chemical or toxic compound exposures, ionizing radiation, some pathogens, and
human genetics.
 Cancer symptoms and signs depend on the specific type and grade of cancer;
although general signs and symptoms are not very specific the following can be
found in patients with different cancers: fatigue, weight loss, pain, skin changes,
change in bowel or bladder function, unusual bleeding, persistent cough or voice
change, fever, lumps, or tissue masses.
 Although there are many tests to screen and presumptively diagnose cancer, the
definite diagnosis is made by examination of a biopsy sample of suspected cancer
tissue.
 Cancer staging is often determined by biopsy results and helps determine the cancer
type and the extent of cancer spread; staging also helps caregivers determine
treatment protocols. In general, in most staging methods, the higher the number
assigned (usually between 0 to 4), the more aggressive the cancer type or more
widespread is the cancer in the body. Staging methods differ from cancer to cancer
and need to be individually discussed with your health care provider.
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 Treatment protocols vary according to the type and stage of the cancer. Most
treatment protocols are designed to fit the individual patient's disease. However,
most treatments include at least one of the following and may include all: surgery,
chemotherapy, and radiation therapy.
 There are many listed home remedies and alternative treatments for cancers but
patients are strongly recommended to discuss these before use with their cancer
doctors.
 The prognosis of cancer can range from excellent to poor. The prognosis depends on
the cancer type and its staging with those cancers known to be aggressive and those
staged with higher numbers (3 to 4) often have a prognosis that ranges more
toward poor.
Introduction and Definitions
In the most basic terms, cancer refers to cells that grow out-of-control and invade other
tissues. Cells become cancerous due to the accumulation of defects, or mutations, in their
DNA. Certain factors lead to cancer and they include:
 inherited genetic defects

 infections,
 environmental factors (for example, air pollution), and
 poor lifestyle choices -- such as smoking and heavy alcohol use -- can also damage
DNA and lead to cancer.
Most of the time, cells are able to detect and repair DNA damage. If a cell is severely
damaged and cannot repair itself it undergoes the so-called programmed cell death or
apoptosis. Cancer occurs when damaged cells grow, divide, and spread abnormally instead
of self-destructing as they should.
Cancer: This is the uncontrolled growth of abnormal cells anywhere in a body. These
abnormal cells are termed cancer cells, malignant cells, or tumor cells. These cells can
infiltrate normal body tissues.
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Many cancers and the abnormal cells that compose the cancer tissue are further identified
by the name of the tissue that the abnormal cells originated from (for example, breast
cancer, lung cancer, colon cancer). Cancer is not confined to humans; animals and other
living organisms can get cancer. Frequently, cancer cells can break away from this original
mass of cells, travel through the blood and lymph systems, and lodge in other organs where
they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an
area and growing in another body area is termed metastatic spread or metastasis. For
example, if breast cancer cells spread to a bone, it means that the individual has metastatic
breast cancer to bone. This is not the same as "bone cancer," which would mean the cancer
had started in the bone.
The following table (National Cancer Institute 2016) gives the estimated numbers of new
cases and deaths for each common cancer type:
Cancer Type Estimated New Cases Estimated Deaths
Bladder 76,960 16,390
Breast (Female -- Male) 246,660 -- 2,600 40,450 -- 440
Colon and Rectal (Combined) 134,490 49,190
Endometrial 60,050 10,470
Kidney (Renal Cell and Renal Pelvis) Cancer 62,700 14,240
Leukemias 60,140 24,400
Lung (Including Bronchus) 224,390 158,080
Melanoma 76,380 10,130
Non-Hodgkin Lymphoma 72,580 20,150
Pancreatic 53,070 41,780
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Cancer Type Estimated New Cases Estimated Deaths
Prostate 180,890 26,120
Thyroid 64,300 1,980
The three most common cancers in men, women, and children in the U.S. are as follows:
 Men: Prostate, lung, and colorectal

 Women: Breast, lung, and colorectal
 Children: Leukemia, brain tumors, and lymphoma
The incidence of cancer and cancer types are influenced by many factors such as age,
gender, race, local environmental factors, diet, and genetics. Consequently, the incidence of
cancer and cancer types vary depending on these variable factors. For example, the World
Health Organization (WHO) provides the following general information about cancer
worldwide:
 Cancer is a leading cause of death worldwide. It accounted for 8.2 million deaths
(around 22% of all deaths not related to communicable diseases; most recent data
from WHO).
 Lung, stomach, liver, colon, and breast cancer cause the most cancer deaths each
year.
 Deaths from cancer worldwide are projected to continue rising, with an estimated
13.1 million deaths in 2030 (about a 70% increase).
Different areas of the world may have cancers that are either more or less predominant
than those found in the U.S. One example is that stomach cancer is often found in Japan,
while it is rarely found in the U.S. This usually represents a combination of environmental
and genetic factors.
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Risk Factors
Anything that may cause a normal body cell to develop abnormally potentially can cause
cancer. Many things can cause cell abnormalities and have been linked to cancer
development. Some cancer causes remain unknown while other cancers have
environmental or lifestyle triggers or may develop from more than one known cause. Some
may be developmentally influenced by a person's genetic makeup. Many patients develop
cancer due to a combination of these factors. Although it is often difficult or impossible to
determine the initiating event(s) that cause a cancer to develop in a specific person,
research has provided clinicians with a number of likely causes that alone or in concert
with other causes, are the likely candidates for initiating cancer. The following is a listing of
major causes and is not all-inclusive as specific causes are routinely added as research
advances:
1. Chemical or toxic compound exposures: Benzene, asbestos, nickel, cadmium,

vinyl chloride, benzidine, N-nitrosamines, tobacco or cigarette smoke (contains at
least 66 known potential carcinogenic chemicals and toxins), asbestos, and aflatoxin
2. Ionizing radiation: Uranium, radon, ultraviolet rays from sunlight, radiation from
alpha, beta, gamma, and X-ray-emitting sources
3. Pathogens: Human papillomavirus (HPV), EBV or Epstein-Barr virus,
hepatitisviruses B and C, Kaposi's sarcoma-associated herpes virus (KSHV), Merkel
cell polyomavirus, Schistosoma spp., and Helicobacter pylori; other bacteria are
being researched as possible agents.
4. Genetics: A number of specific cancers have been linked to human genes and are as
follows: breast, ovarian, colorectal, prostate, skin and melanoma; the specific genes
and other details are beyond the scope of this general article so the reader is
referred to the National Cancer Institute for more details about genetics and cancer.
It is important to point out that almost everyone has risk factors for cancer and is exposed
to cancer-causing substances (for example, sunlight, secondary cigarette smoke, and X-
rays) during their lifetime, but many individuals do not develop cancer. In addition, many
people have the genes that are linked to cancer but do not develop it. Why? Although
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researchers may not be able give a satisfactory answer for every individual, it is clear that
the higher the amount or level of cancer-causing materials a person is exposed to, the
higher the chance the person will develop cancer. In addition, the people with genetic links
to cancer may not develop it for similar reasons (lack of enough stimulus to make the genes
function). In addition, some people may have a heightened immune response that controls
or eliminates cells that are or potentially may become cancer cells. There is evidence that
even certain dietary lifestyles may play a significant role in conjunction with the immune
system to allow or prevent cancer cell survival. For these reasons, it is difficult to assign a
specific cause of cancer to many individuals.
Recently, other risk factors have been added to the list of items that may increase cancer
risk. Specifically, red meat (such as beef, lamb, and pork) was classified by the
International Agency for Research on Cancer as a high-risk agent for potentially causing
cancers; in addition processed meats (salted, smoked, preserved, and/or cured meats)
were placed on the carcinogenic list. Individuals that eat a lot of barbecued meat may also
increase risk due to compounds formed at high temperatures. Other less defined situations
that may increase the risk of certain cancers include obesity, lack of exercise, chronic
inflammation, and hormones, especially those hormones used for replacement therapy.
Other items such as cell phones have been heavily studied. In 2011, the World Health
Organization classified cell phone low energy radiation as "possibly carcinogenic," but
this is a very low risk level that puts cell phones at the same risk as caffeine and pickled
vegetables.
Proving that a substance does not cause or is not related to increased cancer risk is
difficult. For example, antiperspirants are considered to possibly be related to breast
cancer by some investigators and not by others. The official stance by the NCI is "additional
research is needed to investigate this relationship and other factors that may be involved."
This unsatisfying conclusion is presented because the data collected so far is contradictory.
Other claims that are similar require intense and expensive research that may never be
done. Reasonable advice might be to avoid large amounts of any compounds even remotely
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linked to cancer, although it may be difficult to do in complex, technologically advanced
modern societies.
Symptoms and Signs
Symptoms and signs of cancer depend on the type of cancer, where it is located, and/or
where the cancer cells have spread. For example, breast cancer may present as a lump in
the breast or as nipple discharge while metastatic breast cancer may present with
symptoms of pain (if spread to bones), extreme fatigue (lungs), or seizures (brain). A few
patients show no signs or symptoms until the cancer is far advanced.
The American Cancer Society describes seven warning signs and/or symptoms that a
cancer may be present, and which should prompt a person to seek medical attention. The
word CAUTION can help you remember these.
 Change in bowel or bladder habits

 Asore throat that does not heal
 Unusual bleeding or discharge (for example, nipple secretions or a "sore" that will
not heal that oozes material)
 Thickening or lump in the breast, testicles, or elsewhere
 Indigestion (usually chronic) or difficulty swallowing
 Obvious change in the size, color, shape, or thickness of a wart or mole
 Nagging cough or hoarseness
Other signs or symptoms may also alert you or your doctor to the possibility of your having
some form of cancer. These include the following:
 Unexplained loss of weight or loss of appetite

 A new type of pain in the bones or other parts of the body that may be steadily
worsening, or come and go, but is unlike previous pains one has had before
 Persistent fatigue, nausea, or vomiting
 Unexplained low-grade fevers with may be either persistent or come and go
 Recurring infections which will not clear with usual treatment
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Many cancers will present with some of the above general symptoms but often have one or
more symptoms that are more specific for the cancer type. For example, lung cancer may
present with common symptoms of pain, but usually the pain is located in the chest. The
patient may have unusual bleeding, but the bleeding usually occurs when the patient
coughs. Lung cancer patients often become short of breath and then become very fatigued.
Types of Cancer
There are over 200 types of cancer. However, the NCI lists several general categories (see
list in first section of this article). This list is expanded below to list more specific types of
cancers found in each general category; it is not all inclusive and the cancers listed in
quotes are the general names of some cancers:
 Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal
organs -- "skin, lung, colon, pancreatic, ovarian cancers," epithelial, squamous and
basal cell carcinomas, melanomas, papillomas, and adenomas
 Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other
connective or supportive tissue -- "bone, soft tissue cancers," osteosarcoma,
synovial sarcoma, liposarcoma, angiosarcoma, rhabdosarcoma, and fibrosarcoma
 Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and
causes large numbers of abnormal blood cells to be produced and enter the blood --
"leukemia," lymphoblastic leukemias (ALL and CLL), myelogenous leukemias (AML
and CML), T-cell leukemia, and hairy-cell leukemia
 Lymphoma and myeloma: Cancers that begin in the cells of the immune system --
"lymphoma," T-cell lymphomas, B-cell lymphomas, Hodgkin lymphomas, non-
Hodgkin lymphoma, and lymphoproliferative lymphomas
 Central nervous system cancers: Cancers that begin in the tissues of the brain and
spinal cord -- "brain and spinal cord tumors," gliomas, meningiomas, pituitary
adenomas, vestibular schwannomas, primary CNS lymphomas, and primitive
neuroectodermal tumors
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Not included in the above types listed are metastatic cancers; this is because metastatic
cancer cells usually arise from a cell type listed above and the major difference from the
above types is that these cells are now present in a tissue from which the cancer cells did
not originally develop. Consequently, if the terms "metastatic cancer" is used, for accuracy,
the tissue from which the cancer cells arose should be included. For example, a patient may
say they have or are diagnosed with "metastatic cancer" but the more accurate statement is
"metastatic (breast, lung, colon, or other type) cancer with spread to the organ in which it
has been found." Another example is the following: A doctor describing a man whose
prostate cancer has spread to his bones should say the man has metastatic prostate cancer
to bone. This is not "bone cancer," which would be cancer that started in the bone cells.
Metastatic prostate cancer to bone is treated differently than lung cancer to bone.
Cancer Specialists
A doctor who specializes in the treatment of cancer is called an oncologist. He or she may
be a surgeon, a specialist in radiation therapy, or a medical oncologist. The first uses
surgery to treat the cancer; the second, radiation therapy; the third, chemotherapy and
related treatments. Each may consult with the others to develop a treatment plan for the
particular patient.
In addition, other specialists may be involved depending upon where the cancer is located.
For example, ob-gyn specialists may be involved with uterine cancer while an
immunologist maybe involved in treatment of cancers that occur in the immune system.
Your primary care physician and main oncologist will help you to determine what
specialists are best to be members of your treatment team.
Diagnosis
Some cancers are diagnosed during routine screening examinations. These are usually tests
that are routinely done at a certain age. Many cancers are discovered when you present to
your health care professional with specific symptoms. A physical exam and medical history,
especially the history of symptoms, are the first steps in diagnosing cancer. In many
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instances, the medical caregiver will order a number of tests, most of which will be
determined by the type of cancer and where it is suspected to be located in or on the
person's body. In addition, most caregivers will order a complete blood count, electrolyte
levels and, in some cases, other blood studies that may give additional information.
Imaging studies are commonly used to help physicians detect abnormalities in the body
that may be cancer. X-rays, CT and MRI scans, and ultrasound are common tools used to
examine the body. Other tests such as endoscopy, which with variations in the equipment
used, can allow visualization of tissues in the intestinal tract, throat, and bronchi that may
be cancerous. In areas that cannot be well visualized (inside bones or some lymph nodes,
for example), radionuclide scanning is often used. The test involves ingestion or IV
injection of a weakly radioactive substance that can be concentrated and detected in
abnormal tissue.
The preceding tests can be very good at localizing abnormalities in the body; many
clinicians consider that some of the tests provide presumptive evidence for the diagnosis of
cancer. However, in virtually all patients, the definitive diagnosis of cancer is based on the
examination of a tissue sample taken in a procedure called a biopsy from the tissue that
may be cancerous, and then analyzed by a pathologist. Some biopsy samples are relatively
simple to procure (for example, skin biopsy or intestinal tissue biopsy done with a device
called an endoscope equipped with a biopsy attachment). Other biopsies may require as
little as a carefully guided needle, or as much as a surgery (for example, brain tissue or
lymph node biopsy). In some instances, the surgery to diagnose the cancer may result in a
cure if all of the cancerous tissue is removed at the time of biopsy.
The biopsy can provide more than the definitive diagnosis of cancer; it can identify the
cancer type (for example, the type of tissue found may indicate that the sample is from a
primary [started there] or metastatic type of brain cancer [spread from another primary
tumor arising elsewhere in the body]) and thereby help to stage the cancer. The stage, or
cancer staging, is a way for clinicians and researchers to estimate how extensive the cancer
is in the patient's body.
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Is the cancer that has been found localized to its site of origin, or is it spread from that site
to other tissues? A localized cancer is said to be at an early stage, while one which has
spread is at an advanced stage. The following section describes the general staging
methods for cancers.
Cancer Staging
There are a number of different staging methods used for cancers and the specific staging
criteria varies among cancer types. According to the NCI, the common elements considered
in most staging systems are as follows:
 Site of the primary tumor

 Tumor size and number of tumors
 Lymph node involvement (spread of cancer into lymph nodes)
 Cell type and tumor grade (how closely the cancer cells resemble normal tissue
cells)
 The presence or absence of metastasis
However, there are two main methods that form the basis for the more specific or
individual cancer type staging. The TMN staging is used for most solid tumors while the
Roman numeral or stage grouping method is used by some clinicians and researchers on
almost all cancer types.
The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph
nodes (N), and the presence of distant metastasis (M). A number is added to each letter to
indicate the size or extent of the primary tumor and the extent of cancer spread (higher
number means bigger tumor or more spread).
The following is how the NCI describes the TNM staging system:
1. Primary tumor (T)

o TX - Primary tumor cannot be evaluated
o T0 - No evidence of primary tumor
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o Tis - Carcinoma in situ (CIS; abnormal cells are present but have not spread
to neighboring tissue; although not cancer, CIS may become cancer and is
sometimes called pre-invasive cancer)
o T1, T2, T3, T4 - Size and/or extent of the primary tumor
2. Regional lymph nodes (N)
o NX - Regional lymph nodes cannot be evaluated
o N0 - No regional lymph node involvement
o N1, N2, N3 - Involvement of regional lymph nodes (number of lymph nodes
and/or extent of spread)
3. Distant metastasis (M)
o MX - Distant metastasis cannot be evaluated (some clinicians do not ever use
this designation)
o M0 - No distant metastasis
o M1 - Distant metastasis is present
Consequently, a person's cancer could be listed as T1N2M0, meaning it is a small tumor

(T1), but has spread to some regional lymph nodes (N2), and has no distant metastasis
(M0).
The Roman numeral or stage grouping method is described by the NCI as follows:
Stage Definition
Stage 0 Carcinoma in situ.
Stage I Higher numbers indicate more extensive disease: Larger

tumor size and/or spread of the cancer beyond the organ
Stage II
in which it first developed to nearby lymph nodes and/or
Stage III organs adjacent to the location of the primary tumor
Stage IV The cancer has spread to another organ(s).
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As mentioned above, variations of these staging methods exist. For example, some cancer
registries use surveillance, epidemiology, and end results program (SEER) termed
summary staging. SEER groups cancer cases into five main categories:
 In situ: Abnormal cells are present only in the layer of cells in which they
developed.
 Localized: Cancer is limited to the organ in which it began, without evidence of
spread.
 Regional: Cancer has spread beyond the primary site to nearby lymph nodes or
organs and tissues.
 Distant: Cancer has spread from the primary site to distant organs or distant lymph
nodes.
 Unknown: There is not enough information to determine the stage.
Staging of cancer is important; it helps the physician to decide on the most effective
therapeutic protocols, provides a basis for estimating the prognosis (outcome) for the
patient, and provides a system to communicate the patient's condition to other health
professionals that become involved with the patients' care.
Cancer Treatment
The cancer treatment is based on the type of cancer and the stage of the cancer. In some
people, diagnosis and treatment may occur at the same time if the cancer is entirely
surgically removed when the surgeon removes the tissue for biopsy. Although patients may
receive a unique sequenced treatment, or protocol, for their cancer, most treatments have
one or more of the following components: surgery, chemotherapy, radiation therapy, or
combination treatments (a combination of two or all three treatments).
Individuals obtain variations of these treatments for cancer. Patients with cancers that
cannot be cured (completely removed) by surgery usually will get combination therapy, the
composition determined by the cancer type and stage. Palliative therapy (medical care or
treatment used to reduce disease symptoms but unable to cure the patient) utilizes the
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same treatments described above. It is done with the intent to extend and improve the
quality of life of the terminally ill cancer patient. There are many other palliative
treatments to reduce symptoms such as pain medications and antinausea medications.
Cancer Prognosis
The prognosis (outcome) for cancer patients may range from excellent to poor. The
prognosis is directly related to both the type and stage of the cancer. For example, many
skin cancers can be completely cured by removing the skin cancer tissue; similarly, even a
patient with a large tumor may be cured after surgery and other treatments like
chemotherapy (note that a cure is often defined by many clinicians as a five-year period
with no reoccurrence of the cancer). However, as the cancer type either is or becomes
aggressive, with spread to lymph nodes or is metastatic to other organs, the prognosis
decreases. For example, cancers that have higher numbers in their staging (for example,
stage III or T3N2M1; see staging section above) have a worse prognosis than those with
low (or 0) numbers. As the staging numbers increase, the prognosis worsens and the
survival rate decreases.
However, cancers in general have a decreasing life expectancy as the stage of the cancer
increases. Depending on the type of the cancer, as the prognosis decreases, so does life
expectancy. On the positive side, cancers that are treated and do not recur (no remissions)
within a five-year period in general suggest that the patient will have a normal life
expectancy. Some patients will be cured, and a few others may get recurrent cancer.
Unfortunately, there are no guarantees.
There are many complications that may occur with cancer; many are specific to the cancer
type and stage and are too numerous to list here. However, some general complications
that may occur with both cancer and its treatment protocols are listed below:
 Fatigue (both due to cancer and its treatments)

 Anemia (both)
 Loss of appetite (both)
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 Insomnia (both)
 Hair loss (treatments mainly)
 Nausea (both)
 Lymphedema (both)
 Pain (both)
 Immune system depression (both)
Cancer Prevention
Prevention of cancer, by avoiding its potential causes, is the simplest method.
1. Never start smoking tobacco.

2. Avoiding excess sunlight (by decreasing exposure or applying sunscreen) and many
of the chemicals and toxins are excellent ways to avoid cancers.
3. Avoiding contact with certain viruses and other pathogens also are likely to prevent
some cancers.
4. People who have to work close to cancer-causing agents (chemical workers, X-ray
technicians, ionizing radiation researchers, asbestos workers) should follow all
safety precautions and minimize any exposure to such compounds.
5. Although the FDA and the CDC suggests that there is no scientific evidence that
definitively says cell phones cause cancer, other agencies call for more research or
indicate the risk is very low. Individuals who are concerned can limit exposure to
cell phones by using an earpiece and simply make as few cell phone calls as possible.
6. There are two vaccines currently approved by the U.S. Food and Drug
Administration (FDA) to prevent specific types of cancer. Vaccines against the
hepatitis B virus, which is considered a cause of some liver cancers, and vaccines
against human papillomavirus (HPV) types 16 and 18 are available. According to the
NCI, these viruses are responsible for about 70% of cervical cancers. These virus
also plays a role in cancers arising in the head and neck, as well as cancers in the
anal region, and probably in others. Today, vaccination against HPV is
recommended in teenagers and young adults of both sexes. The HPV virus is so
common that by the age of 50, half or more people have evidence of being exposed
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to it. Sipuleucel-T is a new vaccine approved by the FDA to help treat advanced
prostate cancer. Although vaccine does not cure prostate cancer, it has been shown
to help extend the lifespan of individuals with advanced prostate cancer.
7. People with a genetic predisposition to develop certain cancers and others with a
history of cancers in their genetically linked relatives currently cannot change their
genetic makeup. However, some individuals who have a high possibility of
developing genetically linked cancer have taken actions to prevent cancer
development. For example, some young women who have had many family
members develop breast cancer have elected to have their breast tissue removed
even if they have no symptoms or signs of cancer development to reduce or
eliminate the possibility they will develop breast cancer. Some doctors consider this
as an extreme measure to prevent cancer while others do not.
Cancer Screening
Screening tests and studies for cancer are meant to help detect a cancer at an early stage
when the cancer is more likely to be potentially cured with treatment. Such screening
studies are breast exams, testicular exams, colon-rectal exams (colonoscopy),
mammography, certain blood tests, prostate exams, urine tests and others. People who
have any suspicion that they may have cancer should discuss their concerns with their
doctor as soon as possible. Screening recommendations have been the subject of numerous
conflicting reports in recent years. Screening may not be cost effective for many groups of
patients or lead to unnecessary further invasive tests, but individual patients' unique
circumstances should always be considered by doctors in making recommendations about
ordering or not ordering screening tests.
Cancer Treatment
Cancer treatment is the use of surgery, radiation, medications and other therapies to cure a
cancer, shrink a cancer or stop the progression of a cancer. Many cancer treatments exist.
Depending on the particular situation, one may receive one treatment or they may receive
a combination of treatments.
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Reason for Treatment
The goal of cancer treatment is to achieve a cure for the cancer, allowing one to live a
normal life span. This may or may not be possible, depending on one’s specific situation. If
a cure isn't possible, the treatments may be used to shrink the cancer or slow the growth of
cancer to allow one to live symptom free for as long as possible.
Cancer treatments may be used as:
 Primary treatment. The goal of a primary treatment is to completely remove the

cancer from the body or kill all the cancer cells. Any cancer treatment can be used as a
primary treatment, but the most common primary cancer treatment for the most
common types of cancer is surgery. If the cancer is particularly sensitive to radiation
therapy or chemotherapy, on may receive one of those therapies as their primary
treatment.
 Adjuvant treatment. The goal of adjuvant therapy is to kill any cancer cells that may
remain after primary treatment in order to reduce the chance that the cancer will
recur. Any cancer treatment can be used as an adjuvant therapy. Common adjuvant
therapies include chemotherapy, radiation therapy and hormone therapy.
Neo-adjuvant therapy is similar, but treatments are used before the primary
treatment in order to make the primary treatment easier or more effective.
 Palliative treatment. Palliative treatments may help relieve side effects of treatment
or signs and symptoms caused by cancer itself. Surgery, radiation, chemotherapy and
hormone therapy can all be used to relieve symptoms. Other medications may relieve
symptoms such as pain and shortness of breath. Palliative treatment can be used at
the same time as other treatments intended to cure your cancer.
Expectations
Many cancer treatments are available. The treatment options will depend on several
factors, such as the type and stage of the cancer, the general health, and one’s preferences.
Cancer treatment options include:
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 Surgery. The goal of surgery is to remove the cancer or as much of the cancer as
possible.
 Chemotherapy. Chemotherapy uses drugs to kill cancer cells.
 Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-

rays or protons, to kill cancer cells. Radiation treatment can come from a machine
outside your body (external beam radiation), or it can be placed inside your body
(brachytherapy).
 Bone marrow transplant. Your bone marrow is the material inside your bones that
makes blood cells from blood stem cells. A bone marrow transplant, also knowns as a
stem cell transplant, can use your own bone marrow stem cells or those from a donor.
A bone marrow transplant allows your doctor to use higher doses of chemotherapy to
treat your cancer. It may also be used to replace diseased bone marrow.
 Immunotherapy. Immunotherapy, also known as biological therapy, uses the body's

immune system to fight cancer. Cancer can survive unchecked in the body because the
immune system doesn't recognize it as an intruder. Immunotherapy can help the
immune system "see" the cancer and attack it.
 Hormone therapy. Some types of cancer are fueled by the body's hormones.
Examples include breast cancer and prostate cancer. Removing those hormones from
the body or blocking their effects may cause the cancer cells to stop growing.
 Targeted drug therapy. Targeted drug treatment focuses on specific abnormalities

within cancer cells that allow them to survive.
4) Type2 diabetes
Overview
Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar
(glucose) — an important source of fuel for the body. With type 2 diabetes, the body either
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resists the effects of insulin — a hormone that regulates the movement of sugar into the
cells — or doesn't produce enough insulin to maintain normal glucose levels.
Type 2 diabetes used to be known as adult-onset diabetes, but today more children are
being diagnosed with the disorder, probably due to the rise in childhood obesity. There's
no cure for type 2 diabetes, but losing weight, eating well and exercising can help manage
the disease. If diet and exercise aren't enough to manage your blood sugar well, you may
also need diabetes medications or insulin therapy.
Symptoms
Signs and symptoms of type 2 diabetes often develop slowly. In fact, one can have type 2
diabetes for years and not know it. Look for:
 Increased thirst
 Frequent urination
 Increased hunger
 Unintended weight loss
 Fatigue
 Blurred vision
 Slow-healing sores
 Frequent infections
 Areas of darkened skin, usually in the armpits and neck
Causes
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas
is unable to produce enough insulin. Exactly why this happens is unknown, although
genetics and environmental factors, such as being overweight and inactive, seem to be
contributing factors.
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How insulin works
Insulin is a hormone that comes from the gland situated behind and below the stomach
(pancreas).
 The pancreas secretes insulin into the bloodstream.
 The insulin circulates, enabling sugar to enter your cells.
 Insulin lowers the amount of sugar in your bloodstream.
 As your blood sugar level drops, so does the secretion of insulin from your pancreas.
The role of glucose
Glucose — a sugar — is a main source of energy for the cells that make up muscles and
other tissues.
 Glucose comes from two major sources: food and your liver.
 Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
 Your liver stores and makes glucose.
 When your glucose levels are low, such as when you haven't eaten in a while, the liver
breaks down stored glycogen into glucose to keep your glucose level within a normal
range.
In type 2 diabetes, this process doesn't work well. Instead of moving into the cells, sugar
builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta
cells in the pancreas release more insulin, but eventually these cells become impaired and
can't make enough insulin to meet the body's demands. In the much less common type 1
diabetes, the immune system mistakenly destroys the beta cells, leaving the body with little
to no insulin.
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Risk factors
Factors that may increase your risk of type 2 diabetes include:
 Weight. Being overweight is a main risk factor for type 2 diabetes. However, one does
not have to be overweight to develop type 2 diabetes.
 Fat distribution. If one stores fat mainly in the abdomen, they have a greater risk of
type 2 diabetes than if they store fat elsewhere, such as in the hips and thighs. The
risk of type 2 diabetes rises if one is a man with a waist circumference above 40
inches (101.6 centimeters) or a woman with a waist that's greater than 35 inches
(88.9 centimeters).
 Inactivity. The less active one is, the greater their risk of type 2 diabetes. Physical
activity helps in controlling one’s weight, uses up glucose as energy and makes the
cells more sensitive to insulin.
 Family history. The risk of type 2 diabetes increases if the parent or sibling has type
2 diabetes.
 Race. Although it's unclear why, people of certain races — including black, Hispanic,
American Indian and Asian-American people — are more likely to develop type 2
diabetes than white people are.
 Age. The risk of type 2 diabetes increases as one gets older, especially after age 45.
That's probably because people tend to exercise less, lose muscle mass and gain
weight as they age. But type 2 diabetes is also increasing dramatically among children,
adolescents and younger adults.
 Prediabetes. Prediabetes is a condition in which the blood sugar level is higher than

normal, but not high enough to be classified as diabetes. Left untreated, prediabetes
often progresses to type 2 diabetes.
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 Gestational diabetes. If one developed gestational diabetes when they were
pregnant, their risk of developing type 2 diabetes increases. If one gave birth to a baby
weighing more than 9 pounds (4 kilograms), they also at risk of type 2 diabetes.
 Polycystic ovarian syndrome. For women, having polycystic ovarian syndrome — a

common condition characterized by irregular menstrual periods, excess hair growth
and obesity — increases the risk of diabetes.
 Areas of darkened skin, usually in the armpits and neck. This condition often
indicates insulin resistance.
Complications
Type 2 diabetes can be easy to ignore, especially in the early stages when one is feeling fine.
But diabetes affects many major organs, including the heart, blood vessels, nerves, eyes and
kidneys. Controlling the blood sugar levels can help prevent these complications.
Although long-term complications of diabetes develop gradually, they can eventually be

disabling or even life-threatening. Some of the potential complications of diabetes include:
 Heart and blood vessel disease. Diabetes dramatically increases the risk of heart
disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
 Nerve damage (neuropathy). Excess sugar can cause tingling, numbness, burning or

pain that usually begins at the tips of the toes or fingers and gradually spreads
upward. Eventually, you may lose all sense of feeling in the affected limbs. Damage to
the nerves that control digestion can cause problems with nausea, vomiting, diarrhea
or constipation. For men, erectile dysfunction may be an issue.
 Kidney damage. Diabetes can sometimes lead to kidney failure or irreversible end-
stage kidney disease, which may require dialysis or a kidney transplant.
 Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and
glaucoma, and may damage the blood vessels of the retina, potentially leading to
blindness.
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 Slow healing. Left untreated, cuts and blisters can become serious infections, which
may heal poorly. Severe damage might require toe, foot or leg amputation.
 Hearing impairment. Hearing problems are more common in people with diabetes.
 Skin conditions. Diabetes may leave one more susceptible to skin problems,

including bacterial and fungal infections.
 Sleep apnea. Obstructive sleep apnea is common in people with type 2 diabetes.

Obesity may be the main contributing factor to both conditions. Treating sleep apnea
may lower your blood pressure and make one feel more rested, but it's not clear
whether it helps improve blood sugar control.
 Alzheimer's disease. Type 2 diabetes seems to increase the risk of Alzheimer's

disease, though it's not clear why. The worse the blood sugar control, the greater the
risk appears to be.
Prevention
Healthy lifestyle choices can help prevent type 2 diabetes, and that's true even when one
has diabetes in the family. If they have already received a diagnosis of diabetes, one can use
healthy lifestyle choices to help prevent complications. If one has prediabetes, lifestyle
changes can slow or stop the progression to diabetes.
A healthy lifestyle includes:
 Eating healthy foods. Choose foods lower in fat and calories and higher in fiber.
Focus on fruits, vegetables and whole grains.
 Getting active. Aim for a minimum of 30 to 60 minutes of moderate physical activity

— or 15 to 30 minutes of vigorous aerobic activity — on most days. Take a brisk daily
walk. Ride a bike. Swim laps. If you can't fit in a long workout, spread your activity
throughout the day.
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 Losing weight. If you're overweight, losing 5 to 10 percent of body weight can reduce
the risk of diabetes. To keep weight in a healthy range, one should focus on
permanent changes to their eating and exercise habits.
 Avoiding being sedentary for long periods. Sitting still for long periods can
increase your risk of type 2 diabetes. Try to get up every 30 minutes and move around
for at least a few minutes.
Sometimes medication is an option as well. Metformin (Glucophage, Glumetza, others), an

oral diabetes medication, may reduce the risk of type 2 diabetes. But even if you take
medication, healthy lifestyle choices remain essential for preventing or managing diabetes.
5) Gout
Overview
Gout is a common and complex form of arthritis that can affect anyone. It's characterized
by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the
joint at the base of the big toe. An attack of gout can occur suddenly, often waking one up in
the middle of the night with the sensation that their big toe is on fire. The affected joint is
hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Gout symptoms may come and go, but there are ways to manage symptoms and prevent
flares.
Symptoms
The signs and symptoms of gout almost always occur suddenly, and often at night. They
include:
 Intense joint pain. Gout usually affects the large joint of the big toe, but it can occur
in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists
and fingers. The pain is likely to be most severe within the first four to 12 hours after
it begins.
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 Lingering discomfort. After the most severe pain subsides, some joint discomfort
may last from a few days to a few weeks. Later attacks are likely to last longer and
affect more joints.
 Inflammation and redness. The affected joint or joints become swollen, tender,

warm and red.
 Limited range of motion. As gout progresses, you may not be able to move your
joints normally.
Causes
Gout occurs when urate crystals accumulate in the joint, causing the inflammation and
intense pain of a gout attack. Urate crystals can form when one has high levels of uric acid
in their blood.
The body produces uric acid when it breaks down purines — substances that are found
naturally in the body. Purines are also found in certain foods, such as steak, organ meats
and seafood. Other foods also promote higher levels of uric acid, such as alcoholic
beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, uric acid dissolves in the blood and passes through the kidneys into urine. But
sometimes either the body produces too much uric acid or the kidneys excrete too little
uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate
crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Risk factors
One is more likely to develop gout if they have high levels of uric acid in their body. Factors
that increase the uric acid level in the body include:
 Diet. Eating a diet rich in meat and seafood and drinking beverages sweetened with
fruit sugar (fructose) increase levels of uric acid, which increase one’s risk of gout.
Alcohol consumption, especially of beer, also increases the risk of gout.
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 Obesity. If one is overweight, their body produces more uric acid and their kidneys
have a more difficult time eliminating uric acid.
 Medical conditions. Certain diseases and conditions increase one’s risk of gout.

These include untreated high blood pressure and chronic conditions such as diabetes,
metabolic syndrome, and heart and kidney diseases.
 Certain medications. The use of thiazide diuretics — commonly used to treat

hypertension — and low-dose aspirin also can increase uric acid levels. So can the use
of anti-rejection drugs prescribed for people who have undergone an organ
transplant.
 Family history of gout. If other members of one’s family have had gout, then they
more likely to develop the disease.
 Age and sex. Gout occurs more often in men, primarily because women tend to have
lower uric acid levels. After menopause, however, women's uric acid levels approach
those of men. Men are also more likely to develop gout earlier — usually between the
ages of 30 and 50 — whereas women generally develop signs and symptoms after
menopause.
 Recent surgery or trauma. Experiencing recent surgery or trauma has been

associated with an increased risk of developing a gout attack.
Complications
People with gout can develop more-severe conditions, such as:
 Recurrent gout. Some people may never experience gout signs and symptoms again.
Others may experience gout several times each year. Medications may help prevent
gout attacks in people with recurrent gout. If left untreated, gout can cause erosion
and destruction of a joint.
 Advanced gout. Untreated gout may cause deposits of urate crystals to form under
the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as
your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles.
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Tophi usually aren't painful, but they can become swollen and tender during gout
attacks.
 Kidney stones. Urate crystals may collect in the urinary tract of people with gout,
causing kidney stones. Medications can help reduce the risk of kidney stones.
Prevention
During symptom-free periods, these dietary guidelines may help protect against future
gout attacks:
 Drink plenty of fluids. One should stay well-hydrated, including plenty of water.

Limit how many sweetened beverages they drink, especially those sweetened with
high-fructose corn syrup.
 Limit or avoid alcohol. Recent evidence suggests that beer may be particularly likely
to increase the risk of gout symptoms, especially in men.
 Get your protein from low-fat dairy products. Low-fat dairy products may actually
have a protective effect against gout, so these are the best-bet protein sources.
 Limit your intake of meat, fish and poultry. A small amount may be tolerable, but
one should pay close attention to what types — and how much — seem to cause
problems for them.
 Maintain a desirable body weight. Choose portions that allow you to maintain a

healthy weight. Losing weight may decrease uric acid levels in your body. But avoid
fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.
Diagnosis
Tests to help diagnose gout may include:
 Joint fluid test where the doctor may use a needle to draw fluid from the affected
joint. Urate crystals may be visible when the fluid is examined under a microscope.
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 Blood test. The doctor may recommend a blood test to measure the levels of uric acid
and creatinine in the blood. Blood test results can be misleading, though. Some people
have high uric acid levels, but never experience gout. And some people have signs and
symptoms of gout, but don't have unusual levels of uric acid in their blood.
 X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint
inflammation.
 Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a

tophus. This technique is more widely used in Europe than in the United States.
 Dual energy CT scan. This type of imaging can detect the presence of urate crystals
in a joint, even when it is not acutely inflamed. This test is not used routinely in
clinical practice due to the expense and is not widely available.
Treatment
Treatment for gout usually involves medications. Gout medications can be used to treat
acute attacks and prevent future attacks. Medications can also reduce the risk of
complications from gout, such as the development of tophi from urate crystal deposits.
Medications to treat gout attacks
Drugs used to treat acute attacks and prevent future attacks include:
 Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter

options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as
well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or
celecoxib (Celebrex). Doctors may prescribe a higher dose to stop an acute attack,
followed by a lower daily dose to prevent future attacks. NSAIDs carry risks of
stomach pain, bleeding and ulcers.
 Colchicine. A doctor may recommend colchicine (Colcrys, Mitigare), a type of pain
reliever that effectively reduces gout pain. The drug's effectiveness may be offset,
however, by side effects such as nausea, vomiting and diarrhea, especially if taken in
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large doses. After an acute gout attack resolves, a doctor may prescribe a low daily
dose of colchicine to prevent future attacks.
 Corticosteroids. Corticosteroid medications, such as the drug prednisone, may
control gout inflammation and pain. Corticosteroids may be in pill form, or they can
be injected into one’s joint.
Corticosteroids are generally used only in people with gout who can't take either
NSAIDs or colchicine. Side effects of corticosteroids may include mood changes,
increased blood sugar levels and elevated blood pressure.
Medications to prevent gout complications
Options include:
 Medications that block uric acid production. Drugs called xanthine oxidase

inhibitors (XOIs), including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat
(Uloric), limit the amount of uric acid the body makes. This may lower the blood's uric
acid level and reduce the risk of gout.
Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects
include rash, nausea and reduced liver function.
 Medication that improves uric acid removal. These drugs, called uricosurics,

include probenecid (Probalan) and lesinurad (Zurampic). Uricosuric drugs improve
your kidneys' ability to remove uric acid from the body. This may lower your uric acid
levels and reduce the risk of gout, but the level of uric acid in the urine is increased.
Side effects include a rash, stomach pain and kidney stones.
6) Gastroesophageal Reflux Disease (GERD)

GERD is irritation and inflammation of the esophagus due to reflux of gastric acid into the
esophagus.
A three-pronged approach is used to treat GERD: lifestyle modification, including nutrition
therapy; drug therapy; and surgical intervention, if necessary. Lifestyle and diet
modifications focus on reducing or eliminating behaviors believed to contribute to GERD
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Nutritional care of GERD includes avoiding eating within 3 hours before going to bed;
avoiding fatty foods, chocolate, peppermint, and spearmint, which may relax the lower
esophageal sphincter; and coffee and alcoholic beverages, which may increase gastric
secretion. Consumption of these items may need to be limited depending on individual
tolerance
Causes
 Irritating effect of acidic gastric reflux on the oesophageal mucosa
 Stress
 Ingestion of an irritating agent
 Viral inflammation
 Fungal infection
 Intubation
 Aging
 Radiation such as for lung cancer treatment
 Medication that gets stuck in oesophagus e.g. tetracycline
 Chronic or reflux esophagitis is a result of recurrent gastroesophageal reflux owing
to a hiatal hernia, reduced Lower Oesophageal Sphincter (LES) pressure, increased
abdominal pressure and recurrent vomiting.
Symptoms
 Heartburn
 Regurgitation
 Dysphagia
 Bleeding
Nutrition implication
 Indigestion
 Anaemia
Aims of nutritional management
 Prevent irritation of the oesophageal mucosa in the acute phase
 Prevent oesophageal reflux
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 Decrease the irritating capacity or acidity of gastric juice
Dietary Management
 In acute phase give liquid diet that is less abrasive to the oesophagus
 Avoid acidic foods e.g. citrus fruits, tomato products, coffee, carbonated beverages,
alcohol and spices (all of which lower LES) according to individual tolerance.
 Provide low fat foods and small frequent meals
 Timing of the evening meal is important. The patient should consume nothing
except water for 3 hours before lying down
 Avoid or quit smoking as it also triggers acid production
 Elevate the head of the bed when sleeping
 Avoid clothing that is tight on the abdominal area and maintain upright posture
during and after eating.
 Reduce weight if overweight
Peptic Ulcer
An ulcer is an erosion of the mucous membrane
Peptic ulcer disease includes esophageal, gastric and duodenual ulcers. It normally involves
the gastric and duodenal regions of the gastrointestinal tract.
 peptic ulcers – ulcers of the stomach or duodenum
 gastric ulcer – ulcer in the stomach
 duodenal ulcer – ulcer occurring in the duodenum
Research identifies the Helicobacter (H.) pylori bacteria as the primary cause in 95% of
gastric and duodenal ulcers. The remaining 5% is caused by non-steroidal anti-
inflammatory medication usage (e.g. aspirin and ibuprofen) and excessive production of
stomach acid.
Because the primary cause of peptic ulcers is Helicobacter pylori infection, the focus of
treatment is the elimination of the bacteria with antibiotic and proton pump inhibitor
therapy; and cimetidine.
The antibiotics kill the bacteria, and cimetidine inhibits acid secretion in the stomach and
thus helps to heal the ulcer.
Antacids containing calcium carbonate can also be prescribed to neutralize any excess acid.
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Stress management may also be beneficial in the treatment of ulcers. Dietary advice for
persons with peptic ulcers is to avoid alcohol, coffee (with and without caffeine), chocolate,
and specific spices, such as black pepper.
Sufficient low-fat protein should be provided but not in excess because of its ability to
stimulate gastric acid secretion. It is recommended that clients receive no less than 0.8
gram of protein per kilogram of body weight. However, if there has been blood loss, protein
may be increased to 1 or 1.5 grams per kilogram of body weight.
Vitamin and mineral supplements, especially iron if there has been hemorrhage, may be
prescribed.
Although fat inhibits gastric secretions, because of the danger of atherosclerosis, the
amount of fat in the diet should not be excessive.
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Carbohydrates have little effect on gastric acid secretion.
NB: Alcohol and aspirin irritate the mucous membrane of the stomach, and cigarette
smoking decreases the secretion of the pancreas that buffers gastric acid in the duodenum
Medical Approaches for Peptic Ulcer Disease

Medical Approaches Rationale
Avoid foods not tolerated Eliminate foods that cause pain or
discomfort to the patient during the acute
phases
Antisecretory medication (histamine H2 Reduces gastric acid and pepsin secretion
antagonist blocker)
Cimetidine (Tagamet), Ranitidine (Zantac)
Famotidine (Pepcid), Nizatidine (Axid)
Antibiotics Inhibits growth and destroys
microorganisms, i.e, H. pylori bacteria
Antacids Buffers acidity
Sucralfate (carafate) Forms protective coating over ulcer
Nutritional implications of peptic ulcers

It could lead to:
 Anaemia
 Altered food and nutrient intake
Aims of nutrition management
 Reducing and neutralizing stomach acid secretion
 Maintaining acid resistance of gastro-intestinal epithelial tissue
 Limiting patient’s discomfort and reliving their pain
 To provide continuous neutralization of gastric acid
 To promote healing and reduce irritation of GIT
 Restoring good nutrition status
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 To reduce mechanical, thermal and chemical irritation to the gastric mucosa
The patient with peptic ulcer disease should:

 Eat three regular meals daily
 Eat small meals to avoid stomach distension
 Eat slowly
 Use in moderation easily digested fats like fat of whole milk, egg yolk, cream and
butter
 Avoid drinking excess coffee and alcohol
 Cut down on or quit smoking
 Avoid using large amounts of aspirin, other NSAID’s or other drugs known to
damage the stomach lining
 Avoid foods or drinks that cause discomfort
 Eat meals in a relaxed atmosphere as possible
 Take antacids one and three hours after meals and before bedtime
Bland diet
 Moderate in fibre and connective tissues
 Little or no condiments or spices except salt in small amounts
 Avoid or eliminate highly acid foods
 Foods simply prepared
Foods to avoid
 Fatty and tough meat
 Fried foods
 Sour foods
 Unripe citrus fruits like oranges and sweet lime
 Garlic
 Ginger strongly flavoured vegetables
 Strong spices and condiments
 Chillies, pickles
 Strong tea and coffee
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 Alcoholic beverages
Foods recommended for use

 Cabbage: fresh juice, fermented or raw has anti-inflammatory effects
 Potatoes: nutritious, anti-acid, soothing and sedating
 Other vegetables: carrots, peas, okra, other leafy vegetables that are tolerated
(capsicum)
 Fruits: orange juice, apples, ripe bananas, avocadoes, pears, pawpaw, apricots,
cherimoya and guava
 Okra: contain mucilage capable of protecting gastric mucosa
 Cereals: porridge, oatmeal, semolina, macaroni products, spaghetti, rice, chapatti
and matoke
 Desserts: custards, ice creams, cakes
 Oils: use polyunsaturated fatty acids
 Beverages: buttermilk, malted milk
 Eggs: boiled, poached, scrambled
 Roast beef and lamb, stewed or baked should be used in moderations because they
contain purines (non-protein substances that stimulate gastric mucosa)
7) Inflammatory Bowel Disease (IBD)

IBD refer to chronic conditions causing inflammation in the gastrointestinal tract. The
inflammation causes malabsorption that often leads bowel to malnutrition. The acute
phases of these diseases occur at irregular intervals and are followed by periods in which
clients are relatively free of symptoms. Inflammatory bowel disease includes Crohn’s
disease and ulcerative colitis. Weight loss, growth impairment, and malnutrition are the
most prevalent nutritional problems observed in IBD. Nutritional support is essential.
Exclusive elemental nutrition has been used in attaining the remission of Crohn’s disease.
However, symptoms tend to recur promptly after resuming the conventional diet.
Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that
involve chronic inflammation of your digestive tract. Types of IBD include:
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 Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers)
in the innermost lining of the large intestine (colon) and rectum.
 Crohn's disease. This type of IBD is characterized by inflammation of the lining of the

digestive tract, which often spreads deep into affected tissues.
Both ulcerative colitis and Crohn's disease usually involve severe diarrhea, abdominal pain,
fatigue and weight loss.IBD can be debilitating and sometimes leads to life-threatening
complications.
Symptoms
Inflammatory bowel disease symptoms vary, depending on the severity of inflammation
and where it occurs. Symptoms may range from mild to severe. One is likely to have
periods of active illness followed by periods of remission.Signs and symptoms that are
common to both Crohn's disease and ulcerative colitis include:
 Diarrhea
 Fever and fatigue
 Abdominal pain and cramping
 Blood in stool
 Reduced appetite
 Unintended weight loss
Causes
The exact cause of inflammatory bowel disease remains unknown. Previously, diet and
stress were suspected, but now doctors know that these factors may aggravate but don't
cause IBD.One possible cause is an immune system malfunction. When the immune system
tries to fight off an invading virus or bacterium, an abnormal immune response causes the
immune system to attack the cells in the digestive tract, too. Heredity also seems to play a
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role in that IBD is more common in people who have family members with the disease.
However, most people with IBD don't have this family history.
Risk factors
 Age. Most people who develop IBD are diagnosed before they're 30 years old. But
some people don't develop the disease until their 50s or 60s.
 Race or ethnicity. Although whites have the highest risk of the disease, it can occur in
any race. If you're of Ashkenazi Jewish descent, your risk is even higher.
 Family history. You're at higher risk if you have a close relative — such as a parent,
sibling or child — with the disease.
 Cigarette smoking. Cigarette smoking is the most important controllable risk factor

for developing Crohn's disease. Although smoking may provide some protection
against ulcerative colitis, the overall health benefits of not smoking make it important
to try to quit.
 Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil,

Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium (Voltaren) and
others. These medications may increase the risk of developing IBD or worsen disease
in people who have IBD.
 Where you live. If you live in an industrialized country, you're more likely to develop
IBD. Therefore, it may be that environmental factors, including a diet high in fat or
refined foods, play a role. People living in northern climates also seem to be at greater
risk.
Complications
Ulcerative colitis and Crohn's disease have some complications in common and others that
are specific to each condition. Complications found in both conditions may include:
 Colon cancer. Having IBD increases the risk of colon cancer. General colon cancer
screening guidelines for people without IBD call for a colonoscopy every 10 years
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beginning at age 50.
 Skin, eye and joint inflammation. Certain disorders, including arthritis, skin lesions
and eye inflammation (uveitis), may occur during IBD flare-ups.
 Medication side effects. Certain medications for IBD are associated with a small risk
of developing certain cancers. Corticosteroids can be associated with a risk of
osteoporosis, high blood pressure and other conditions.
 Primary sclerosing cholangitis. In this condition, inflammation causes scars within

the bile ducts, eventually making them narrow and gradually causing liver damage.
 Blood clots. IBD increases the risk of blood clots in veins and arteries.
Complications of Crohn's disease may include:
 Bowel obstruction. Crohn's disease affects the full thickness of the intestinal wall.
Over time, parts of the bowel can thicken and narrow, which may block the flow of
digestive contents. One may require surgery to remove the diseased portion of their
bowel.
 Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult to eat or

for the intestine to absorb enough nutrients to keep one nourished. It's also common
to develop anemia due to low iron or vitamin B12 caused by the disease.
 Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in the

digestive tract, including the mouth and anus, and in the genital area (perineum).
 Fistulas. Sometimes ulcers can extend completely through the intestinal wall,

creating a fistula — an abnormal connection between different body parts. Fistulas
near or around the anal area (perianal) are the most common kind. In some cases, a
fistula may become infected and form an abscess.
 Anal fissure. This is a small tear in the tissue that lines the anus or in the skin around
the anus where infections can occur. It's often associated with painful bowel
movements and may lead to a perianal fistula.
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Complications of ulcerative colitis may include:
 Toxic megacolon. Ulcerative colitis may cause the colon to rapidly widen and swell, a
serious condition known as toxic megacolon.
 A hole in the colon (perforated colon). A perforated colon most commonly is

caused by toxic megacolon, but it may also occur on its own.
 Severe dehydration. Excessive diarrhea can result in dehydration.
Diagnosis
A doctor will likely diagnose inflammatory bowel disease only after ruling out other
possible causes for the signs and symptoms. To help confirm a diagnosis of IBD, one may
have one or more of the following tests and procedures:
Blood tests
 Tests for anemia or infection. A doctor may suggest blood tests to check for anemia
— a condition in which there aren't enough red blood cells to carry adequate oxygen
to the tissues — or to check for signs of infection from bacteria or viruses.
 Fecal occult blood test. One may need to provide a stool sample so that a doctor can
test for hidden blood in the stool.
Sigmoidoscopy exam
 Colonoscopy. This exam allows the doctor to view the entire colon using a thin,
flexible, lighted tube with an attached camera. During the procedure, the doctor can
also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue
sample can help confirm a diagnosis.
 Flexible sigmoidoscopy. A doctor uses a slender, flexible, lighted tube to examine the
rectum and sigmoid, the last portion of one’s colon. If the colon is severely inflamed, a
doctor may perform this test instead of a full colonoscopy.
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 Upper endoscopy. In this procedure, a doctor uses a slender, flexible, lighted tube to
examine the esophagus, stomach and first part of the small intestine (duodenum).
While it is rare for these areas to be involved with Crohn's disease, this test may be
recommended if you are having nausea and vomiting, difficulty eating or upper
abdominal pain.
 Capsule endoscopy. This test is sometimes used to help diagnose Crohn's disease

involving your small intestine. One swallows a capsule that has a camera in it. The
images are transmitted to a recorder that one wears on their belt, after which the
capsule exits their body painlessly in their stool.
 Balloon-assisted enteroscopy. For this test, a scope is used in conjunction with a

device called an overtube. This enables the doctor to look further into the small bowel
where standard endoscopes don't reach. This technique is useful when a capsule
endoscopy shows abnormalities, but the diagnosis is still in question.
Imaging procedures
 X-ray: of the abdominal area to rule out serious complications, such as a perforated
colon.
 Computerized tomography (CT) scan. A CT scan looks at the entire bowel as well as
at tissues outside the bowel. CT enterography is a special CT scan that provides better
images of the small bowel. This test has replaced barium X-rays in many medical
centers.
 Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio
waves to create detailed images of organs and tissues. An MRI is particularly useful
for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR
enterography). Unlike a CT, there is no radiation exposure with an MRI.
Treatment
The goal of inflammatory bowel disease treatment is to reduce the inflammation that
triggers the signs and symptoms. In the best cases, this may lead not only to symptom relief
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but also to long-term remission and reduced risks of complications. IBD treatment usually
involves either drug therapy or surgery.
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel
disease. Anti-inflammatories include corticosteroids and aminosalicylates, such as
mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum).
Immune system suppressors
These drugs work in a variety of ways to suppress the immune response that releases
inflammation-inducing chemicals in the intestinal lining. For some people, a combination of
these drugs works better than one drug alone.
Some examples of immunosuppressant drugs include azathioprine (Azasan, Imuran),

mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune) and
methotrexate (Trexall).
One class of drugs called tumor necrosis factor (TNF)-alpha inhibitors, or biologics, works
by neutralizing a protein produced by your immune system. Examples include infliximab
(Remicade), adalimumab (Humira) and golimumab (Simponi). Other biologic therapies that
may be used are natalizumab (Tysabri), vedolizumab (Entyvio) and ustekinumab (Stelara).
Antibiotics
Antibiotics may be used in addition to other medications or when infection is a concern —

in cases of perianal Crohn's disease, for example. Frequently prescribed antibiotics include
ciprofloxacin (Cipro) and metronidazole (Flagyl).
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Other medications and supplements
In addition to controlling inflammation, some medications may help relieve the signs and
symptoms, but a patient should always talk to their doctor before taking any over-the-
counter medications. Depending on the severity of the IBD, the doctor may recommend one
or more of the following:
 Anti-diarrheal medications. A fiber supplement — such as psyllium powder

(Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate
diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide
(Imodium A-D) may be effective.
 Pain relievers. For mild pain, for example acetaminophen (Tylenol, others).

However, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and
diclofenac sodium (Voltaren) likely will make your symptoms worse and can make
your disease worse as well.
 Iron supplements. Forpeople with chronic intestinal bleeding there is a risk that
they may develop iron deficiency anemia and need to take iron supplements.
 Calcium and vitamin D supplements. Crohn's disease and steroids used to treat it

can increase the risk of osteoporosis, so one may need to take a calcium supplement
with added vitamin D.
Surgery
If diet and lifestyle changes, drug therapy, or other treatments don't relieve your IBD signs
and symptoms, your doctor may recommend surgery.
 Surgery for ulcerative colitis. Surgery can often eliminate ulcerative colitis. But that
usually means removing one’s entire colon and rectum (proctocolectomy).
In most cases, this involves a procedure called an ileal pouch anal anastomosis. This
procedure eliminates the need to wear a bag to collect stool. A surgeon constructs a
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pouch from the end of the small intestine. The pouch is then attached directly to the
anus, allowing one to expel waste relatively normally.
In some cases a pouch is not possible. Instead, surgeons create a permanent opening
in the abdomen (ileal stoma) through which stool is passed for collection in an
attached bag.
 Surgery for Crohn's disease. Up to one-half of people with Crohn's disease will
require at least one surgery. However, surgery does not cure Crohn's disease.
During surgery, the surgeon removes a damaged portion of the digestive tract and
then reconnects the healthy sections. Surgery may also be used to close fistulas and
drain abscesses.
The benefits of surgery for Crohn's disease are usually temporary. The disease often
recurs, frequently near the reconnected tissue. The best approach is to follow surgery
with medication to minimize the risk of recurrence.
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Communicable vs Non-Communicable Diseases

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Communicable vs Non-Communicable Diseases

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Introduction to Communicable and Non-Communicable Diseases

A communicable disease is an illness due to a specific infectious (biological) agent or its

Viruses, Bacteria, Fungi & Protozoa

 Protozoa: one celled, animal like organisms.

Communicable versus non-communicable diseases

No. Communicable Non- Communicable diseases

Contamination: The presence of an infectious agent on a body surface, on or in clothes,

Infestation: It is the lodgment, development and reproduction of arthropods on the

Reservoir: Any person, animal, arthropod, plant, soil, or substance, or a combination of

Incidence and Prevalence of infectious diseases

Incidence of an infectious disease: Number of new cases in a given time period

Epidemic: “The unusual occurrence in a community of disease, specific health related

Nosocomial infections: Nosocomial (hospital acquired) infection is an infection

Opportunistic infection: This is infection by organisms that take the opportunity

Incubation period:This is the time from exposure to development of disease. In other

(III): Susceptible host

A. Infectious agent (etiology or D. Mode of transmission

An organism that is capable of producing infection or infectious disease.On the basis of

 Metazoa (multicellular organisms). (eg. Helminths).

o Bovine tuberculosis - cow to man

3) Non-living things as reservoir:

Eg.# Clostridium botulinum etiologic agent of Botulism

# Clostridium tetani etiologic agent of Tetanus

C. Portal of exit (mode of escape from the reservoir):

 Mucus membrane  GIT

A person or animal lacking sufficient resistance to a particular pathogenic agent to prevent

 Non-specific factors include:

 Healthy or asymptomatic carriers: These are persons whose infection remains

Prevention; Definition and Concept

Prevention refers to actions aimed at eradicating, eliminating or minimizing the impact of

Successful prevention depends upon:

Leavell’s Levels of Prevention

Stage of disease Level of prevention Type of response

It is the prevention of the emergence or development of risk factors in countries or

Primary prevention may be accomplished by measures of “Health promotion” and “specific

Primary prevention may be accomplished by measures designed to promote general health

Approaches for Primary Prevention

The objectives of primary prevention are to:

Early diagnosis and treatment

Disability limitationDisease >>>>Impairment >>>>Disability>>>> Handicap

Impairment: Impairment is “any loss or abnormality of psychological, physiological or

Disability: Disability is “any restriction or lack of ability to perform an activity in the

Handicap: Handicap is termed as “a disadvantage for a given individual, resulting from an

Rehabilitation: Rehabilitation is “ the combined and coordinated use of medical, social,

Methods of Communicable Disease Control

1) Elimination of the Reservoir

 Successful prevention depends upon a knowledge of causation, dynamics of

Communicable diseases common characteristics of importance

1. They are very common 4. Most of them are preventable fairly

The Communicable Disease Cycle

Summary on Principles of Control of Communicable Diseases

Factors of transmission Control measures

Disease determinant factors

Measures of disease in populations: Epidemiologists use various methods and

How to determine endemic and epidemic diseases

(Students to make Reference to their epidemiology notes)

B. Population based studies

E. Community based studies

Administrative: As noted, data collected for administrative purposes often find a

Effective Communicable diseases control relies on an effective surveillance and response

Integrated disease surveillance predicts all surveillance activities in a country as a common

Surveillance is based on collecting only the information that is required to achieve